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Grand Rounds

Are Older Women with PCOS at Increased Risk of Morbidity and Mortality?

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BACKGROUND AND PURPOSE:

  • Women with polycystic ovary syndrome (PCOS) have increased risk factors for cardiovascular disease (CVD)
    • Whether this translates to an increased risk for cardiovascular events or related mortality is unknown
  • Forslund et al. (European Journal of Obstetrics and Gynecology, 2022) assessed morbidity and mortality among women with a diagnosis of PCOS

METHODS:

  • Prospective cohort study
    • Follow up in 2019 of a prospective cohort of women with PCOS (1956 to 1965)
    • Long-term study, with follow-up previously in 1987 and 2008
  • Participants
    • 72 to 91 years
  • Exposures
    • PCOS (Rotterdam criteria)
    • Age matched non-PCOS reference group
  • Study design
    • For deceased women register data was used
    • Interviews were conducted for women, and medical records were studied
  • Primary outcomes
    • Mortality
    • Cardiovascular morbidity

RESULTS:

  • Women with PCOS: 35 | Age-matched references: 99
    • Mean age: 81 years
  • There was no difference in mortality among women with PCOS
    • All-cause mortality: HR 1.10 (95% CI, 0.66 to 1.98)
    • CVD-related mortality: HR 1.65 (95% CI, 0.66 to 4.29)
  • There was also no difference in cardiovascular-related morbidity among women with PCOS
    • All CVD: HR 1.21 (95% CI, 0.66 to 2.20)
    • Hypertension: HR 1.76 (95% CI, 0.99 to 3.52)
    • Type 2 diabetes: HR 1.65 (95% CI, 0.77 to 3.74)
  • There were also no differences in the following between the women with PCOS and the reference group
    • Blood lipids
    • Glucose levels
    • Insulin levels
    • Thyroid hormone levels
  • Comparing baseline data from the deceased and living women with PCOS, no differences were found regarding
    • Age
    • Menopausal age
    • BMI
    • Homeostasis model assessment of insulin resistance
    • Free androgen index
    • Total testosterone
    • SHBG levels
  • Deceased women with PCOS had a higher waist to hip ratio at baseline (P<0.01)
    • PCOS: 0.87
    • Reference: 0.80

CONCLUSION:

  • There was no increased risk of CVD or mortality in this cohort of elderly women with PCOS
  • While women with PCOS have risk factors associated with CVD in perimenopause, these do not seem to be linked to increased risk later in life
  • The authors state

In conclusion, this 32-year follow-up up to a mean age above 80 years of the Gothenburg PCOS cohort and their age-matched controls, similar in BMI, showed no increase in all-cause mortality or CVD morbidity

Learn More – Primary Sources:

Morbidity and mortality in PCOS: A prospective follow-up up to a mean age above 80 years

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Related ObG Topics:

Evaluation and Treatment of Endometriosis
Does Using Letrozole-Induced Frozen Embryo Transfer Cycles Reduce the Risk of Hypertensive Disorders in Women with PCOS?
PCOS: Targeting Treatments to Improve Reproductive Outcomes and Reduce CVD
Mechanisms Underlying Gestational Weight Gain with PCOS and Effects of Metformin

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