Abstract
Women with polycystic ovary syndrome are characterized by obesity, menstruation irregularity, hirsutism and infertility, and prevalent with cardiometabolic comorbidities, but population-based studies on the risk of developing coronary artery disease are limited. From claims data of the Taiwan National Health Insurance, we identified 8048 women with polycystic ovary syndrome aged 15-49 years newly diagnosed in 1998-2013, and 32192 women without the syndrome and CAD as controls, frequency matched by age and diagnosis date. By the end of 2013, after a mean follow-up period of 5.9 years, the overall incidence of coronary artery disease was 63% higher in women with polycystic ovary syndrome than in controls (2.25 vs. 1.38 per 1000 person-years). The adjusted hazard ratio [aHR] of coronary artery disease was 1.44 (95% confidence interval (CI) = 1.14–1.81) for women with polycystic ovary syndrome, compared with controls. Hazards of coronary artery disease were significant during follow-up periods of 3-4 years (aHR = 1.52, 95% CI = 1.00–2.30) and of 5–9 years (aHR = 1.58, 95% CI = 1.07–2.32). The incidence of coronary artery disease increased further in those with cardiometabolic comorbidities. Among women with polycystic ovary syndrome, those with comorbid diabetes had an incidence of 35.2 per 1000 person-years, 20-fold greater than those without cardiometabolic comorbidities. In conclusion, women with polycystic ovary syndrome are at an elevated risk of coronary artery disease. Preventive interventions should be provided to them, particularly for those with the comorbidity of metabolism symptom.
Highlights
Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive ages
From claims data of the Taiwan National Health Insurance, we identified 8048 women with polycystic ovary syndrome aged 15-49 years newly diagnosed in 19982013, and 32192 women without the syndrome and coronary artery disease (CAD) as controls, frequency matched by age and diagnosis date
The LHID2000 consists of registration files and original claims data from 1996 to 2013 of 1 million beneficiaries randomly selected from the National Health Insurance Research Database (NHIRD; details available at http://nhird.nhri.org.tw/en/index.htm)
Summary
Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive ages. PCOS patients are prevalent with insulin resistance and insulin secretory defects and androgen excess [4,5,6] They are correlated with multiple comorbidities, such as obesity, coronary artery disease (CAD) and cancer [6]. The Coronary Artery Risk Development in Young Adults (CARDIA) study reported recently that PCOS patients are prevalent with CAC with an adjusted odds ratio of 2.70 [8]. These women are at an increased risk of development of subclinical CAD [7]. The CAD mortality in Japan is lower than that in western countries, while the mortality in India is over 6-fold greater than that in Japan or 2-fold greater than that in the US [12]
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