2023 International Evidence-Based Polycystic Ovary Syndrome Guideline Update: Insights From a Systematic Review and Meta-Analysis on Elevated Clinical Cardiovascular Disease in Polycystic Ovary Syndrome.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of observational cohort and case-control studies
PubMed 39119982 · doi:10.1161/JAHA.123.033572
What was done
A systematic review and meta-analysis of five databases (Medline, PsycInfo, EMBASE, All EBM, and CINAHL) was conducted from January 1, 2017, to March 1, 2023, to update the 2018 International PCOS Guideline. The review assessed clinical cardiovascular disease (CVD) event risks in women with versus without polycystic ovary syndrome (PCOS). Investigators extracted data across 20 studies involving 1.06 million women (369,317 with PCOS and 692,963 controls) and pooled odds ratios (ORs), incidence rate ratios (IRRs), and hazard ratios (HRs).
What was found
PCOS was associated with a significantly increased risk across multiple CVD morbidity outcomes: - Composite CVD: OR 1.68 (95% CI, 1.26–2.23; I² = 71.0%) - Composite ischemic heart disease: OR 1.48 (95% CI, 1.07–2.05; I² = 81.0%) - Myocardial infarction: OR 2.50 (95% CI, 1.43–4.38; I² = 83.3%) - Stroke: OR 1.71 (95% CI, 1.20–2.44; I² = 81.4%) Cardiovascular mortality was not significantly elevated (OR 1.19 [95% CI, 0.53–2.69]; I² = 0%). Findings were corroborated by IRR analyses, whereas pooled HR estimates were constrained by high heterogeneity and few studies.
Why it matters
These findings establish PCOS as a clinically meaningful risk factor for cardiovascular events, providing the empirical rationale for the 2023 International Guideline recommendation to perform routine CVD risk screening in patients with PCOS.
Limits
All included data derive from observational studies, introducing potential residual confounding from adiposity and metabolic features. Most morbidity outcomes displayed high statistical heterogeneity (I² ranging from 71.0% to 83.3%). Additionally, few studies provided time-to-event data, limiting robust hazard ratio analyses.
Cited by
- partial Individuals with PCOS are at increased risk of long-latency chronic diseases including heart disease, neurodegeneration, and some cancers.