Lo Andre C Q, Lo Charmaine Chu Wen, Oliver-Williams Clare
School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Rd, Cambridge CB2 0SP, UK.
Liverpool Hospital, Liverpool, NSW 2170, Australia.
Eur Heart J Open. 2023 Jun 9;3(4):oead061. doi: 10.1093/ehjopen/oead061. eCollection 2023 Jul.
Prior meta-analyses indicate polycystic ovary syndrome (PCOS) is associated with cardiovascular diseases (CVDs), but have high statistical heterogeneity, likely because PCOS is a heterogenous syndrome diagnosed by having any two of the three components: hyperandrogenism, oligomenorrhea/menstrual irregularity or polycystic ovaries. Several studies report higher risk of CVDs from individual PCOS components, but a comprehensive assessment of how each component contributes to CVD risk is lacking. This study aims to assess CVD risk for women with one of the PCOS components.
A systematic review and meta-analysis of observational studies was conducted. PubMed, Scopus, and Web of Science were searched without restrictions in July 2022. Studies meeting inclusion criteria examined the association between PCOS components and risk of a CVD. Two reviewers independently assessed abstracts and full-text articles, and extracted data from eligible studies. Where appropriate, relative risk (RR) and 95% confidence interval (CI) were estimated by random-effects meta-analysis. Statistical heterogeneity was assessed using the statistic. Twenty-three studies, including 346 486 women, were identified. Oligo-amenorrhea/menstrual irregularity was associated with overall CVD (RR = 1.29, 95%CI = 1.09-1.53), coronary heart disease (CHD) (RR = 1.22, 95%CI = 1.06-1.41), and myocardial infarction (MI) (RR = 1.37, 95%CI = 1.01-1.88) but not cerebrovascular disease. These results were broadly consistent even after further adjustment for obesity. There was mixed evidence for the role of hyperandrogenism in CVDs. No studies examined polycystic ovaries as an independent exposure for CVD risk.
Oligo-amenorrhea/menstrual irregularity is associated with greater risk of overall CVD, CHD, and MI. More research is needed to assess the risks associated with hyperandrogenism or polycystic ovaries.
既往的荟萃分析表明，多囊卵巢综合征（PCOS）与心血管疾病（CVD）相关，但存在较高的统计异质性，这可能是因为PCOS是一种异质性综合征，通过高雄激素血症、月经过少/月经不规律或多囊卵巢这三个成分中的任意两个来诊断。多项研究报告了PCOS各个成分导致CVD的风险更高，但缺乏对每个成分如何影响CVD风险的综合评估。本研究旨在评估患有PCOS其中一个成分的女性的CVD风险。
对观察性研究进行了系统评价和荟萃分析。2022年7月对PubMed、Scopus和Web of Science进行了无限制检索。符合纳入标准的研究考察了PCOS成分与CVD风险之间的关联。两名评审员独立评估摘要和全文文章，并从符合条件的研究中提取数据。在适当情况下，采用随机效应荟萃分析估计相对风险（RR）和95%置信区间（CI）。使用 统计量评估统计异质性。共纳入23项研究，包括346486名女性。月经过少/月经不规律与总体CVD（RR = 1.29，95%CI = 1.09 - 1.53）、冠心病（CHD）（RR = 1.22，95%CI = 1.06 - 1.41）和心肌梗死（MI）（RR = 1.37，95%CI = 1.01 - 1.88）相关，但与脑血管疾病无关。即使在进一步调整肥胖因素后，这些结果仍大致一致。关于高雄激素血症在CVD中的作用，证据不一。没有研究将多囊卵巢作为CVD风险的独立暴露因素进行考察。
月经过少/月经不规律与总体CVD、CHD和MI的风险增加相关。需要更多研究来评估与高雄激素血症或多囊卵巢相关的风险。
