O-011 Cardiovascular morbidity and mortality in women with PCOS: a cohort study of 75142 participants from the UK biobank

Abstract

Abstract Study question Are women with PCOS at an increased risk of cardiovascular mortality and morbidity? Summary answer Although PCOS is strongly associated with cardiovascular risk factors, it does not increase the risk of cardiovascular morbidity and mortality in women aged 40-60 years. What is known already PCOS is one the commonest endocrinopathies in women of reproductive age characterised by anovulation, hyperandrogenism and polycystic ovaries in ultrasound surveillance. The prevalence of PCOS has been quoted 8 to13% of women in the UK, however, up to 70% of the cases may be undiagnosed. Women with PCOS are at increased risk of developing adverse cardiometabolic outcomes including insulin resistance, type 2 diabetes (T2DM), metabolic syndrome, hypertension and dyslipidaemia. Those unfavourable risk factors would place women with PCOS at an increased risk for cardiovascular mortality and morbidity, however, the evidence from epidemiological studies are so far heterogenous with conflicting results. Study design, size, duration We conducted a cohort study including a total of 75142 participants from the UK biobank, of whom 15747 had PCOS. Women were followed up for 11.1 years in average. Participants/materials, setting, methods The primary outcome was morbidity and mortality from ischemic heart disease and stroke. We constructed Cox regression analysis adjusted for confounders and risk factors to quantify the risk of cardiovascular morbidity and mortality in women with PCOS. Main results and the role of chance The incidence rate of cardiovascular events was 1.92/1000 person years in the PCOS population and 1.90/1000 person years in women without PCOS. PCOS was associated with a higher risk of obesity (OR 1.63, 95% CI 1.56-1.70), hypertension (OR 1.18, 95% CI 1.13-1.23) and type 2 diabetes (OR 1.44, 95% CI 1.31-1.58). In the adjusted cox regression model, PCOS doesn’t increase the risk of CVD morbidity and mortality (HR 0.89, 95% CI 0.78-1.01), however, the cumulative hazard risk in women over 60 years old with a history of PCOS was greater compared to women without PCOS. Limitations, reasons for caution The low response rate (5.5%) to the UK biobank recruitment introduces a healthy responder bias which may limit the representation of the population. PCOS was both self-reported and assessed by clinical and biochemical features and other variables were also self-reported, hence reporting bias cannot be excluded. Wider implications of the findings The strong association of PCOS with cardiometabolic risk factors and that the CVD morbidity/mortality risk becomes comparable with that of women without PCOS after correcting for these factors, highlights the need to strengthen public health strategies for surveillance, lifestyle interventions and prompt treatment of those co-morbidities in women with PCOS. Trial registration number Not applicable