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

Leslee J. Shaw, C. Noel Bairey Merz, Ricardo Azziz, Frank Z. Stanczyk, George Sopko, Glenn D. Braunstein, Sheryl F. Kelsey, Kevin E. Kip, Rhonda M. Cooper-DeHoff, B. Delia Johnson, Viola Vaccarino, Steven E. Reis, Vera Bittner, T. Keta Hodgson, William Rogers, Carl J. Pepine

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368 Scopus citations

Abstract

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 (≥701 pg/ml), testosterone (≥30.9 ng/dl), or free testosterone (≥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. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)1276-1284
Number of pages9
JournalJournal of Clinical Endocrinology and Metabolism
Volume93
Issue number4
DOIs
StatePublished - Apr 2008

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ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical

Cite this

Shaw, L. J., Merz, C. N. B., Azziz, R., Stanczyk, F. Z., Sopko, G., Braunstein, G. D., Kelsey, S. F., Kip, K. E., Cooper-DeHoff, R. M., Johnson, B. D., Vaccarino, V., Reis, S. E., Bittner, V., Hodgson, T. K., Rogers, W., & Pepine, C. J. (2008). 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. Journal of Clinical Endocrinology and Metabolism, 93(4), 1276-1284. https://doi.org/10.1210/jc.2007-0425