Abstract 4062: Progression of Coronary Artery Calcification at Middle Age in Women with Polycystic Ovary Syndrome
Introduction: Polycystic ovary syndrome (PCOS) is a reproductive endocrine disorder characterized by menstrual irregularity, anovulation, and hyperandrogenism, affecting 6 to 10% of all women. PCOS is associated with obesity, insulin resistance and type 2 diabetes. Increased prevalent coronary calcification (CAC), independent of age and BMI in women with PCOS compared to normal women has been documented. CAC has been shown to be a surrogate for increased atherosclerotic disease and is a predictor of future coronary heart disease risk. The present study considered the rate of progression of CAC in middle-aged women with PCOS and in non-PCOS (control) women of similar age.
Methods: A total of 117 PCOS cases and 151 controls aged 35 to 64 years (mean age 47.3 and 49.6) were evaluated at baseline (2001–2003) and again in 2003–2006 for CAC using electron beam computed tomography (EBT) (average follow-up = 2.8 years). The relationship between PCOS and CAC progression was explored with binary logistic regression analyses. CAC progression was defined as a change in CAC volume score of ≥+5 versus >>22>5 mm3/year. Separate models were run including and excluding women with type 2 diabetes and/or taking cholesterol-lowering statins.
Results: At baseline, women with PCOS had a higher prevalence (and increased severity) of CAC (63.2%) compared with controls (41.7%). Annual progression of at least 5 mm3 was found in 24.8% of PCOS cases and 13.9% of controls. PCOS was a significant predictor of CAC progression in the total sample after adjustment for age and BMI (p= 0.034). PCOS was no longer significant when baseline CAC was included in the model. Results were similar when women with type 2 diabetes and/or on statins at baseline (n=26) were removed from the analysis.
Discussion: Women with PCOS are at higher risk for premature CAC than reproductively normal women. However, by middle age, the rate of progression of CAC in women is mediated more significantly by prevalent CAC than by the presence of PCOS alone. These findings suggest that among women with PCOS, clinical and lifestyle interventions to reduce cardiovascular disease risk should be be initiated in early adulthood before the appearance of prevalent CAC to impact later life development of CHD.