Polycystic ovary syndrome and black race are associated with increased blood pressure

Abstract

IntroductionPolycystic ovary syndrome (PCOS) is the most common endocrinopathy in reproductive age women and is associated with comorbidities including obesity, type II diabetes and hypertension. Few studies have focused on older reproductive age women (i.e., > 30 yrs) with PCOS, when blood pressure (BP) and cardiovascular disease (CVD) risks begin to increase. We tested the hypotheses that PCOS in older reproductive age women are associated with greater systolic, diastolic, and mean BP (SBP, DBP, & MAP), and that the BP relationships are independent of BMI.MethodsWe used EHR data provided by the Joint Data Analytics Team (JDAT) at the Yale School of Medicine. We examined women evaluated for new‐patient diagnoses, follow‐op, or infertility evaluations/procedures by the same provider between 10/7/11 to 12/23/15. Of the 13,951 women, n=261 with PCOS and n=168 controls (diagnosed with tubal and/or male factor infertility) were identified. BP measurements were measured at the time of or following the diagnosis of PCOS or male factor/tubal infertility. We used t‐tests to determine group differences in BP and BMI, and multivariable linear regressions to determine associations. Regressions were adjusted for age, race, and BMI; the interaction between PCOS and BMI was examined using a BMI centered product term and accounted for in the final model. The data were then stratified by BMI (obese, BMI ≥ 30 kg/m2) vs non‐obese, BMI < 30 kg/m2) and a multivariable linear regression model adjusted for age and race was used to examine PCOS as a predictor of BP indices in obese versus non‐obese women.ResultsAge and BMI were greater in PCOS, (36±3 yr; 33±9 kg/m2) versus Controls (37±3 yr; 28±7 kg/m2, p<0.001), while racial breakdown was similar: PCOS: 72% white, 11% black, 4% Asian, 15% Hispanic, and Controls: 60% white, 18% black, 8% Asian, 20% Hispanic. Respectively, the SBP, DBP, & MAP for PCOS (122±13; 77±10; 92±10) were greater vs Controls (116±15; 73±10, 88±11, p<0.001). Our multivariable linear regression model demonstrated an interaction between PCOS and BMI with negative slopes (β), (r2=0.176, β= ‐0.216, p=0.030; r2=0.181, β=‐0.294, p=0.003; r2=0.203, β=‐0.282, p=0.004, for SBP, DBP, & MAP respectively). When stratified by BMI, racial breakdown for groups was similar: N=242 obese group, 67% PCOS, BMI=38 ±6 kg/m2, age=36±3 yr, 65% white, 19% black, 20% Hispanic, and N=187 non‐obese group, 52% PCOS, BMI=24±3 kg/m2, age=36±3 yr, 70% white, 7% black, 13% Hispanic. In a model adjusted for age and race, PCOS predicted SBP, DBP, and MAP in the obese group (r2=0.073, p<0.001; r2=0.061, p=0.001; r2=0.073, p<0.001) but not in the non‐obese group (r2=0.018, p=0.269; r2=0.034, p=0.050; r2=0.025, p=0.078). Additionally, in the obese‐group, black race significantly predicted SBP (r2=0.073, p=0.018) and MAP (r2=0.073, p<0.028), although race was not a significant factor in the non‐obese group.ConclusionThese data show that in older reproductive age women with obesity, PCOS and black race are independent predictors of worsening BP indices. NIH 5 T35 HL 7649‐35.