Abstract

BACKGROUND

Polycystic ovary syndrome (PCOS) is associated with cardiometabolic disease, but recent systematic reviews and meta-analyses of longitudinal studies that quantify these associations are lacking.

OBJECTIVE AND RATIONALE

Is PCOS a risk factor for cardiometabolic disease?

SEARCH METHODS

We searched from inception to September 2019 in MEDLINE and EMBASE using controlled terms (e.g. MESH) and text words for PCOS and cardiometabolic outcomes, including cardiovascular disease (CVD), stroke, myocardial infarction, hypertension (HT), type 2 diabetes (T2D), metabolic syndrome and dyslipidaemia. Cohort studies and case–control studies comparing the prevalence of T2D, HT, fatal or non-fatal CVD and/or lipid concentrations of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides (TGs) between women with and without PCOS of ≥18 years of age were eligible for this systematic review and meta-analysis. Studies were eligible regardless of the degree to which they adjusted for confounders including obesity. Articles had to be written in English, German or Dutch. Intervention studies, animal studies, conference abstracts, studies with a follow-up duration less than 3 years and studies with less than 10 PCOS cases were excluded. Study selection, quality assessment (Newcastle–Ottawa Scale) and data extraction were performed by two independent researchers.

OUTCOMES

Of the 5971 identified records, 23 cohort studies were included in the current systematic review. Women with PCOS had increased risks of HT (risk ratio (RR): 1.75, 95% CI 1.42 to 2.15), T2D (RR: 3.00, 95% CI 2.56 to 3.51), a higher serum concentration of TC (mean difference (MD): 7.14 95% CI 1.58 to 12.70 mg/dl), a lower serum concentration of HDL-C (MD: −2.45 95% CI −4.51 to −0.38 mg/dl) and increased risks of non-fatal cerebrovascular disease events (RR: 1.41, 95% CI 1.02 to 1.94) compared to women without PCOS. No differences were found for LDL-C (MD: 3.32 95% CI −4.11 to 10.75 mg/dl), TG (MD 18.53 95% CI −0.58 to 37.64 mg/dl) or coronary disease events (RR: 1.78, 95% CI 0.99 to 3.23). No meta-analyses could be performed for fatal CVD events due to the paucity of mortality data.

WIDER IMPLICATIONS

Women with PCOS are at increased risk of cardiometabolic disease. This review quantifies this risk, which is important for clinicians to inform patients and to take into account in the cardiovascular risk assessment of women with PCOS. Future clinical trials are needed to assess the ability of cardiometabolic screening and management in women with PCOS to reduce future CVD morbidity.

中文翻译：

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女性多囊卵巢综合征患者长期代谢性心脏病风险：系统评价和荟萃分析

摘要

背景

多囊卵巢综合征（PCOS）与心脏代谢疾病有关，但目前缺乏量化这些关联的纵向研究的系统综述和荟萃分析。

目的和理由

PCOS是心脏代谢疾病的危险因素吗？

搜索方法

从开始到2019年9月，我们在MEDLINE和EMBASE中使用受控词（例如MESH）和PCOS和心脏代谢结果的文本词进行搜索，包括心血管疾病（CVD），中风，心肌梗塞，高血压（HT），2型糖尿病（T2D） ，代谢综合征和血脂异常。队列研究和病例对照研究比较了T2D，HT，致命或非致命CVD的患病率和/或总胆固醇（TC），低密度脂蛋白胆固醇（LDL-C），高密度脂蛋白胆固醇（有和没有PCOS≥18岁的女性之间的HDL-C）和甘油三酸酯（TGs）均适用于此系统评价和荟萃分析。不论对肥胖等混杂因素的适应程度如何，研究均符合条件。文章必须以英语，德语或荷兰语撰写。干预研究，动物研究，会议摘要，随访时间少于3年的研究以及PCOS病例少于10例的研究被排除在外。两名独立研究人员进行了研究选择，质量评估（纽卡斯尔-渥太华量表）和数据提取。

结果

在5971个已识别记录中，当前的系统评价包括23个队列研究。患有PCOS的女性罹患HT的风险增加（风险比（RR）：1.75，95％CI 1.42至2.15），T2D（RR：3.00，95％CI 2.56至3.51），TC的血清浓度更高（平均差异（MD） ）：7.14 95％CI 1.58至12.70 mg / dl），较低的HDL-C血清浓度（MD：-2.45 95％CI -4.51至-0.38 mg / dl）和非致命性脑血管疾病事件的风险增加（ RR：1.41，与没有PCOS的女性相比，95％CI为1.02至1.94）。LDL-C（MD：3.32 95％CI −4.11至10.75 mg / dl），TG（MD 18.53 95％CI −0.58至37.64 mg / dl）或冠心病事件（RR：1.78，95％）没有发现差异CI 0.99至3.23）。由于缺乏死亡率数据，因此无法对致命的CVD事件进行荟萃分析。

暗示

患有PCOS的女性患心脏代谢疾病的风险增加。这篇综述对这种风险进行了量化，这对于临床医生告知患者并在PCOS妇女的心血管风险评估中予以考虑非常重要。需要进一步的临床试验来评估PCOS妇女降低其CVD发病率的心脏代谢筛查和管理能力。