Association between Polycystic Ovaries and Extent of Coronary Artery Disease in Women Having Cardiac Catheterization

Abstract

BACKGROUND: Women with polycystic ovaries have associated risk factors for coronary artery disease. It is unknown whether women with more extensive coronary artery disease are more likely to have polycystic ovaries. OBJECTIVE: To determine whether women who have more extensive coronary artery disease as seen on coronary angiography are more likely to have polycystic ovaries appearing on ultrasonography than are women with less severe coronary disease. DESIGN: Prevalence study of women who had had coronary angiography. SETTING: Women referred for coronary angiography for assessment of chest pain or valvular disease in Auckland, New Zealand, during a 2-year period. PATIENTS: 143 women 60 years of age or younger who had had coronary angiography. Women who had previously had bilateral oophorectomy were excluded. MEASUREMENTS: The extent of coronary artery disease assessed by quantitative angiography was compared with the presence or absence of polycystic ovaries. Pelvic ultrasonography was done without knowledge of the extent of coronary artery disease. Assessment of angiograms was blinded. Insulin resistance and gonadotropin, testosterone, and serum lipid levels were also measured. RESULTS: Polycystic ovaries were found in 42% of women and were associated with hirsutism; previous hysterectomy; higher free testosterone, triglyceride, and C-peptide levels; and lower high-density lipoprotein cholesterol levels. Women with polycystic ovaries had more extensive coronary artery disease than women with normal ovaries (number of segments with > 50% stenosis, 1.7 [95% CI, 1.1 to 2.3] compared with 0.82 [CI, 0.54 to 1.1]; P < 0.01). On logistic regression analysis, the extent of coronary artery disease (P = 0.032) and family history of heart disease (P = 0.022) were predictors of the presence of polycystic ovaries. CONCLUSIONS: In women having coronary angiography, those with more extensive coronary artery disease were more likely to have polycystic ovaries on ultrasonography than were those with less extensive disease. Visualization of polycystic ovaries by sonography was associated with distinct metabolic and endocrine abnormalities. Further study is required to evaluate whether surgery or hormone replacement therapy can modify the risk.