Oral Presentation ESA-SRB 2023 in conjunction with ENSA

Cardiovascular risk in PCOS is associated with diabetes and hypertension: A case control linked data study in Western Australian women (#103)

Kharis Burns 1 2 , Alexander Stuckey 3 4 , Kevin Trentino 2 , Gerald Watts 2 5 , Frank Sanfilippo 6 7 , Bronwyn Stuckey 2 8 9
  1. Department of Endocrinology and Diabetes, Royal Perth Hospital, Perth, WA, Australia
  2. Medical School, University of Western Australia, Crawley, WA, Australia
  3. School of Agriculture and Environment, University of Western Australia, Crawley, WA, Australia
  4. Pink Lake Analytics, Nedlands, WA, Australia
  5. Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia
  6. School of Population and Global Health, University of Western Australia, Crawley, Western Australia, Australia
  7. Pharmacy Department, Royal Perth Hospital, Perth, Western Australia, Australia
  8. Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
  9. Keogh Institute for Medical Research, Nedlands, WA, Australia

Increased cardiovascular (CV) risk in polycystic ovary syndrome (PCOS) is assumed, based on associated risk factors including insulin resistance. Previous research is conflicting owing to heterogeneity in study design and definitions of both PCOS and CV disease (CVD). This retrospective cohort study examined CV outcomes using a uniformly diagnosed cohort of women with PCOS vs. controls using linked health data.

NIH-defined PCOS patients were identified from endocrinology clinics in Western Australia. Control women were identified from the WA electoral role and matched, 1(case):4(controls), by age, sex, postcode and Indigenous status. Clinical data for the cases were linked with administrative data from the Western Australian (WA) Data Linkage System.

CV outcomes were identified from linked hospital admissions, and included coronary heart disease, heart failure, atrial fibrillation/arrhythmia, cardiac arrest, cerebrovascular disease, and peripheral vascular disease. Events were examined collectively, based on a composite of these outcomes, and as individual outcomes. Multivariable stratified Cox proportional hazards regression models with time-dependent covariates were used to examine the effect of PCOS on CV outcomes.

Overall, 1035 PCOS-affected women and 4148 controls were followed for an average of 33.0 (SD 9.6) years. PCOS cases had higher incidence of diabetes, hypertension, COPD and fatty liver; these covariates were included as time dependent variables in models. Unadjusted hazard ratios showed significantly higher risk of both overall CVD (ICD-9_CM codes 390-459, ICD-10-AM I00-I99) (HR 1.33, CI 1.14-1.56) and the composite CV endpoint (unadjusted HR 1.55, CI 1.07-2.24). However, following adjustment for the time dependent variables the HR for composite CV outcome in cases vs. controls was 1.17 (95% CI 0.81-1.68).

The difference in findings following adjustment for diabetes and hypertension, implies that PCOS per se is not the cause of differences in CV outcome. Instead, this suggests traditional CV risk factors drive CV risk in women with PCOS.