Emergence of ovulatory cycles with aging in women with polycystic ovary syndrome (PCOS) alters the trajectory of cardiovascular and metabolic risk factors

Abstract STUDY QUESTION: What alters cardiovascular and metabolic risk factors with aging in women with polycystic ovary syndrome (PCOS)? SUMMARY ANSWER: Lipid parameters, mainly low-density lipoprotein (LDL) cholesterol, increase with aging, but not in women who attain ovulatory cycles. WHAT IS KNOWN ALREADY: Cardiovascular and metabolic parameters tend to increase with aging, but this has not been shown in a prospective longitudinal study in women with PCOS. Correlates of these changes have not been identified. STUDY DESIGN: A prospective cohort of 118 hyperandrogenic women with PCOS who were followed from the age of 20-25 years at 5 year intervals for 20 years. PARTICIPANTS/MATERIALS, SETTING, METHODS: Thirty-five age-matched controls and another 35 age-matched controls in their 40s, 20 years later. Longitudinal measurements of body mass index (BMI), waist circumference, fasting serum steroids, glucose, insulin, lipids, prevalence of metabolic syndrome and ovulatory status. MAIN RESULTS AND THE ROLE OF CHANCE: After 20 years, in the entire group, waist circumference increased as did glucose, total cholesterol (C), high-density lipoprotein-C (HDL-C), LDL-C and non-HDL-C. The prevalence of metabolic syndrome was 7% at the beginning and 6% at the end. Fifty-one women with PCOS were found to be ovulatory and 67 remained anovulatory after 20 years. Anovulatory women had higher insulin, lower QUICKI and higher total C, LDL-C, non-HDL-C and lower HDL-C. In ovulatory women there were no alterations in lipids or glucose and minor changes in insulin and QUICKI compared with controls. None of the parameters were influenced by BMI or waist circumference. LIMITATIONS, REASONS FOR CAUTION: Inability to follow controls for 20 years. Associations observed between ovulatory function and lowered cardiovascular and metabolic risks cannot imply cause and effect. WIDER IMPLICATIONS OF THE FINDINGS: Phenotypic variability, particularly ovulatory function, in women diagnosed to have PCOS appears to influence cardiovascular and metabolic risks. It is unclear if these data pertain to other populations and ethnicities of women. STUDY FUNDING/COMPETING INTERESTS: Self-funded; no conflicts of interest.