Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam, The Netherlands.
Hum Reprod Update. 2020 Nov 1;26(6):942-960. doi: 10.1093/humupd/dmaa029.
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.
Is PCOS a risk factor for cardiometabolic disease?
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.
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.
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.
多囊卵巢综合征（PCOS）与心血管代谢疾病相关，但目前缺乏对定量评估这些关联的纵向研究的系统评价和荟萃分析。
PCOS 是否是心血管代谢疾病的风险因素？
我们在 MEDLINE 和 EMBASE 中从建库到 2019 年 9 月，使用受控术语（例如 MESH）和 PCOS 及心血管代谢结局的文本词（包括心血管疾病[CVD]、中风、心肌梗死、高血压[HT]、2 型糖尿病[T2D]、代谢综合征和血脂异常）进行检索。本系统评价和荟萃分析纳入了比较≥18 岁女性中 PCOS 与非 PCOS 患者 T2D、HT、致命或非致命 CVD 及/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（HDL-C）和甘油三酯（TG）浓度的队列研究和病例对照研究。无论调整了多少混杂因素（包括肥胖），研究均符合纳入标准。文章必须用英语、德语或荷兰语撰写。干预研究、动物研究、会议摘要、随访时间<3 年的研究以及 PCOS 病例<10 例的研究均被排除。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。
在 5971 条确定的记录中，有 23 项队列研究被纳入本系统评价。与非 PCOS 女性相比，PCOS 女性发生 HT（风险比[RR]：1.75，95%CI 1.42 至 2.15）、T2D（RR：3.00，95%CI 2.56 至 3.51）、血清 TC 浓度更高（平均差[MD]：7.14，95%CI 1.58 至 12.70mg/dl）、血清 HDL-C 浓度更低（MD：-2.45，95%CI -4.51 至 -0.38mg/dl）和非致命性脑血管病事件风险增加（RR：1.41，95%CI 1.02 至 1.94）。LDL-C（MD：3.32，95%CI -4.11 至 10.75mg/dl）、TG（MD 18.53，95%CI -0.58 至 37.64mg/dl）或冠心病事件（RR：1.78，95%CI 0.99 至 3.23）无差异。由于死亡率数据不足，无法对致命性 CVD 事件进行荟萃分析。
患有 PCOS 的女性发生心血管代谢疾病的风险增加。本综述定量评估了这种风险，这对临床医生告知患者并在评估 PCOS 女性的心血管风险时考虑到这一点非常重要。需要进行未来的临床试验来评估对 PCOS 女性进行心血管代谢筛查和管理以降低未来 CVD 发病率的能力。
