Postmenopausal women with a history of irregular menses and elevated androgen measurements at high risk for worsening cardiovascular event-free survival: results from the National Institutes of Health--National Heart, Lung, and Blood Institute sponsored Women's Ischemia Syndrome Evaluation.
BACKGROUND
Women with polycystic ovary syndrome (PCOS) have a greater clustering of cardiac risk factors. However, the link between PCOS and cardiovascular (CV) disease is incompletely described.


OBJECTIVE
The aim of this analysis was to evaluate the risk of CV events in 390 postmenopausal women enrolled in the National Institutes of Health-National Heart, Lung, and Blood Institute (NIH-NHLBI) sponsored Women's Ischemia Syndrome Evaluation (WISE) study according to clinical features of PCOS.


METHODS
A total of 104 women had clinical features of PCOS defined by a premenopausal history of irregular menses and current biochemical evidence of hyperandrogenemia. Hyperandrogenemia was defined as the top quartile of androstenedione (> or = 701 pg/ml), testosterone (> or = 30.9 ng/dl), or free testosterone (> or = 4.5 pg/ml). Cox proportional hazard model was fit to estimate CV death or myocardial infarction (n = 55).


RESULTS
Women with clinical features of PCOS were more often diabetic (P < 0.0001), obese (P = 0.005), had the metabolic syndrome (P < 0.0001), and had more angiographic coronary artery disease (CAD) (P = 0.04) compared to women without clinical features of PCOS. Cumulative 5-yr CV event-free survival was 78.9% for women with clinical features of PCOS (n = 104) vs. 88.7% for women without clinical features of PCOS (n = 286) (P = 0.006). PCOS remained a significant predictor (P < 0.01) in prognostic models including diabetes, waist circumference, hypertension, and angiographic CAD as covariates.


CONCLUSIONS
Among postmenopausal women evaluated for suspected ischemia, clinical features of PCOS are associated with more angiographic CAD and worsening CV event-free survival. Identification of postmenopausal women with clinical features of PCOS may provide an opportunity for risk factor intervention for the prevention of CAD and CV events.
Shaw
Leslee J
LJ
Division of Cardiology, Department of Medicine, Cedars-Sinai Research Institute, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA. lshaw3@emory.edu
Bairey Merz
C Noel
CN
Azziz
Ricardo
R
Stanczyk
Frank Z
FZ
Sopko
George
G
Braunstein
Glenn D
GD
Kelsey
Sheryl F
SF
Kip
Kevin E
KE
Cooper-Dehoff
Rhonda M
RM
Johnson
B Delia
BD
Vaccarino
Viola
V
Reis
Steven E
SE
Bittner
Vera
V
Hodgson
T Keta
TK
Rogers
William
W
Pepine
Carl J
CJ
D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011085:Polycystic Ovary Syndrome / Q000150:complications*; D017698:Postmenopause; D016016:Proportional Hazards Models; D012307:Risk Factors