Torchen, L. C. (2017). Cardiometabolic Risk in PCOS: More than a Reproductive Disorder. Current diabetes reports, 17(12), 137. https://doi.org/10.1007/s11892-017-0956-2
Torchen LC. Cardiometabolic Risk in PCOS: More than a Reproductive Disorder. Current diabetes reports. 2017;17(12):137. doi:10.1007/s11892-017-0956-2
Torchen, Laura C. "Cardiometabolic Risk in PCOS: More than a Reproductive Disorder." Current diabetes reports, vol. 17, no. 12, 2017, pp. 137.
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RRM Academy Synopsis
PCOS raises type 2 diabetes risk; heart disease risk is unquantified
This 2017 review finds PCOS raises type 2 diabetes risk among affected women, and its heart disease risk remains unquantified. The diabetes risk is well established in the classic phenotype, which carries the greatest metabolic risk. PCOS is now also called polyendocrine metabolic ovarian syndrome (PMOS).
About 3 in 10 adult women with PCOS had impaired glucose tolerance. Source: Torchen LC, 2017, PMID 29128916.Study at a glance, 2017 review of Women with PCOS: PCOS raises type 2 diabetes risk; heart disease risk is unquantified. Source: Torchen LC, 2017, PMID 29128916.
Key Findings
Women with PCOS, lean or obese, had 35–40% lower insulin-mediated glucose disposal than control women of similar age and body composition.
Impaired glucose tolerance affected about 30% of adult women with PCOS and about 30% of affected adolescents, by the estimates the review cites.
Nurses' Health Study data suggested PCOS was associated with a two times higher risk of type 2 diabetes. Irregular menses stood in for the diagnosis.
No prospective, longitudinal studies have investigated cardiovascular events in women with PCOS. Many studies using surrogate endpoints found evidence of increased cardiovascular disease risk.
One study of girls whose mothers have PCOS found a decreased disposition index, a measure of insulin secretion, around puberty. It was still present after 3 years.
Interpretation
This review draws together existing studies on PCOS and metabolic risk. Insulin resistance is common in PCOS but varies between women. Studies using the broader Rotterdam phenotypes may understate the metabolic risk of the NIH phenotype. The findings support larger, longer-term studies of cardiovascular risk in women with PCOS.
RRM Context
Restorative reproductive medicine looks for the underlying cause behind a diagnosis. PMOS, the newer name for PCOS, carries metabolic function in its title. The review sets insulin and glucose findings beside ovulation and androgens as parts of one condition.
Our editorial summary of this paper, not the article's abstract.
Abstract
Purpose of Review
Polycystic ovary syndrome (PCOS) is diagnosed by its characteristic reproductive features. However, PCOS is also associated with metabolic abnormalities, including insulin resistance and β-cell dysfunction. The severity of these abnormalities varies according to the reproductive phenotype, with the so-called NIH or classic phenotype conferring the greatest metabolic risk. The increased risk for type 2 diabetes (T2D) is well established among affected women with the NIH phenotype, but whether PCOS also confers an increased risk for cardiovascular events remains unknown.
Recent Findings
Recent studies in daughters of affected women have found evidence for pancreatic β-cell dysfunction prior to menarche. Further, genetic analyses have provided evidence that metabolic abnormalities such as obesity and insulin resistance contribute to the pathogenesis of PCOS. PCOS increases the risk for T2D. However, the risk for cardiovascular disease has not been quantified, and prospective, longitudinal studies are still critically needed.
PMOS / PCOS has four diagnostic phenotypes and distinct metabolic, reproductive, and mental health implications. How RRM-trained clinicians approach diagnosis and treatment differently.
