Pourahmad Bita, Majidnia Mostafa, Saniee Nadia, Riyahifar Sevda, Moradi Yousef
Department of Nursing and Midwifery, Sa.C, Islamic Azad University, Sanandaj, Iran.
Young Reaserchers and Elite Club, Sa.C., Islamic Azad University, Sanandaj, Iran.
BMC Womens Health. 2025 Aug 5;25(1):385. doi: 10.1186/s12905-025-03927-5.
Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder among women of reproductive age and has been associated with increased risks of hypertension (HTN), stroke, and cardiovascular disease (CVD). However, the magnitude and consistency of these associations remain unclear due to varying diagnostic criteria, study designs, and population characteristics.
To systematically review and meta-analyze observational studies evaluating the association between PCOS and the risks of hypertension, stroke, and CVD.
A systematic literature search was conducted across PubMed, Scopus, Web of Science, Embase, and Cochrane CENTRAL for studies published between January 1, 1990, and January 1, 2025. Eligible studies included cohort, case-control, and cross-sectional designs comparing women with and without PCOS, as defined by established criteria (Rotterdam, NIH, AES, etc.). Data extraction and quality assessment were performed using standardized checklists and the Newcastle-Ottawa Scale. Relative risks (RR) and 95% confidence intervals (CI) were pooled using a random-effects model.
A total of 33 studies on hypertension, 10 on stroke, and 26 on CVD were included. Women with PCOS had significantly increased risk of hypertension (pooled RR: 1.45; 95% CI: 1.32-1.61, I: 82.20%), stroke (pooled RR: 1.28; 95% CI: 1.10-1.49, I: 54.09%), and cardiovascular disease (pooled RR: 1.41; 95% CI: 1.17-1.71, I: 97.05%). The risk of hypertension was most pronounced in cohort studies (RR: 1.47; 95% CI: 1.23-1.76) and in European populations (RR: 1.74; 95% CI: 1.40-2.16). PCOS was also associated with elevated risks of stroke and CVD, independent of body mass index (BMI). Heterogeneity across studies was moderate to high, and no significant publication bias was detected.
PCOS may be linked to an increased risk of hypertension, stroke, and CVD across populations and independent of BMI. Given the high heterogeneity among included studies, these findings should be interpreted with caution. These findings highlight the importance of comprehensive cardiovascular risk assessment and management in women with PCOS. More well-designed, large-scale prospective studies are needed to clarify the underlying mechanisms and improve risk stratification.
多囊卵巢综合征（PCOS）是育龄女性中一种常见的内分泌紊乱疾病，与高血压（HTN）、中风和心血管疾病（CVD）风险增加有关。然而，由于诊断标准、研究设计和人群特征不同，这些关联的程度和一致性仍不明确。
系统评价和荟萃分析评估PCOS与高血压、中风和CVD风险之间关联的观察性研究。
在PubMed、Scopus、Web of Science、Embase和Cochrane CENTRAL数据库中进行系统文献检索，查找1990年1月1日至2025年1月1日发表的研究。符合条件的研究包括队列研究、病例对照研究和横断面研究，比较符合既定标准（鹿特丹、美国国立卫生研究院、美国内分泌学会等）定义的患有和未患有PCOS的女性。使用标准化清单和纽卡斯尔-渥太华量表进行数据提取和质量评估。采用随机效应模型汇总相对风险（RR）和95%置信区间（CI）。
共纳入33项关于高血压的研究、10项关于中风的研究和26项关于CVD的研究。患有PCOS的女性患高血压（汇总RR：1.45；95%CI：1.32-1.61，I²：82.20%）、中风（汇总RR：1.28；95%CI：1.10-1.49，I²：54.09%）和心血管疾病（汇总RR：1.41；95%CI：1.17-1.71，I²：97.05%）的风险显著增加。高血压风险在队列研究（RR：1.47；95%CI：1.23-1.76）和欧洲人群（RR：1.74；9%CI：1.40-2.16）中最为明显。PCOS还与中风和CVD风险升高相关，且独立于体重指数（BMI）。各研究间的异质性为中度到高度，未检测到显著的发表偏倚。
PCOS可能与人群中高血压、中风和CVD风险增加有关，且独立于BMI。鉴于纳入研究间存在高度异质性，这些发现应谨慎解释。这些发现凸显了对PCOS女性进行全面心血管风险评估和管理的重要性。需要更多设计良好且大规模的前瞻性研究来阐明潜在机制并改善风险分层。
