Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, New York.
Fertil Steril. 2022 May;117(5):924-935. doi: 10.1016/j.fertnstert.2022.03.009.
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women of reproductive age and is hallmarked by hyperandrogenism, oligo-ovulation, and polycystic ovarian morphology. Polycystic ovary syndrome, particularly the hyperandrogenism phenotype, is associated with several cardiometabolic abnormalities, including obesity, dyslipidemia, elevated blood pressure, and prediabetes or type 2 diabetes. Many, but not all, studies have suggested that PCOS is associated with increased risk of cardiovascular disease (CVD), including coronary heart disease and stroke, independent of body mass index and traditional risk factors. Interpretation of the data from these observational studies is limited by the varying definitions and ascertainment of PCOS and CVD across studies. Recent Mendelian randomization studies have challenged the causality of PCOS with coronary heart disease and stroke. Future longitudinal studies with clearly defined PCOS criteria and newer genetic methodologies may help to determine association and causality. Nevertheless, CVD risk screening remains critical in this patient population, as improvements in metabolic profile and reduction in CVD risk are achievable with a combination of lifestyle management and pharmacotherapy. Statin therapy should be implemented in women with PCOS who have elevated atherosclerotic CVD risk. If CVD risk is uncertain, measurement of subclinical atherosclerosis (carotid plaque or coronary artery calcium) may be a useful tool to guide shared decision-making about initiation of statin therapy. Other medications, such as metformin and glucagon-like peptide-1 receptor agonists, also may be useful in reducing CVD risk in insulin-resistant populations. Additional research is needed to determine the best pathways to mitigate PCOS-associated CVD risk.
多囊卵巢综合征（PCOS）是育龄妇女中最常见的内分泌疾病，其特征为高雄激素血症、稀发排卵和多囊卵巢形态。多囊卵巢综合征，尤其是高雄激素血症表型，与多种心血管代谢异常有关，包括肥胖、血脂异常、血压升高以及糖尿病前期或 2 型糖尿病。许多（但不是全部）研究表明，多囊卵巢综合征与心血管疾病（CVD）风险增加相关，包括冠心病和中风，这与体重指数和传统危险因素无关。这些观察性研究的数据解释受到研究间多囊卵巢综合征和 CVD 的不同定义和确定方法的限制。最近的孟德尔随机化研究对多囊卵巢综合征与冠心病和中风的因果关系提出了质疑。未来具有明确多囊卵巢综合征标准和新的遗传方法学的纵向研究可能有助于确定相关性和因果关系。尽管如此，心血管疾病风险筛查在该患者群体中仍然至关重要，因为通过生活方式管理和药物治疗的结合，可以改善代谢谱并降低 CVD 风险。具有高动脉粥样硬化性 CVD 风险的多囊卵巢综合征妇女应使用他汀类药物治疗。如果 CVD 风险不确定，检测亚临床动脉粥样硬化（颈动脉斑块或冠状动脉钙）可能是指导他汀类药物治疗开始的决策的有用工具。二甲双胍和胰高血糖素样肽-1 受体激动剂等其他药物也可能有助于降低胰岛素抵抗人群的 CVD 风险。需要进一步研究以确定减轻与多囊卵巢综合征相关的 CVD 风险的最佳途径。
