A new study published in the Journal of the American Heart Association shows that women of reproductive age with Polycystic Ovary Syndrome (PCOS) are at increased risk of cardiovascular events (peripartum cardiomyopathy, heart failure, cardiac arrhythmias, venous thromboembolism, and acute kidney injury) at the time of delivery admissions.1 PCOS is a common endocrine disorder affecting 5-13% of women in the United States. Previously PCOS was known to be associated with long-term cardiovascular complications. However, the current study has shown that women with PCOS can even develop acute CV complications during labor and delivery admissions.
The current study analyzes a national inpatient sample evaluating the data spanning 17 years from 2002 to 2019 and shows an exponential increase in cardiometabolic risk factors such as PCOS and obesity among reproductive age group women in the U.S. The results were notable for women with PCOS to be comparatively older, with higher comorbidities such as diabetes, obesity, and hyperlipidemia. For instance, PCOS prevalence increased from 569 to 15,348 per 100,000 deliveries. Similarly, obesity showed an exponential increase from 5.7% to 28.2%. This suggests poor cardiometabolic health among pregnant women in the U.S has significant public health implications. It is also noteworthy that patients with PCOS were found to have higher rates of pre-eclampsia, peripartum cardiomyopathy, and heart failure. The authors also reported the PCOS group to have longer hospital length of stay and higher cost of hospitalization.
The researchers also examined socioeconomic disparities and found that minority ethnic groups such as African American women and lower-income class groups are at the highest risk of developing cardiac complications. Hence an intervention aimed at this vulnerable population group may be most helpful in preventing future complications. “We want to stress the importance of optimizing the cardiovascular health of women with PCOS with prevention efforts, especially Black women and lower socioeconomic groups because we believe that those are the most vulnerable populations and will benefit most from intervention,” says Salman Zahid, M.D., a resident physician in the Rochester General Hospital Internal Medicine Residency program in Rochester, New York, and lead author of the study.
The author’s work in this area is commendable as the results of this study help in identifying necessary complications of PCOS and also shine a light on socioeconomic disparities. The results of this study can help in making important policy changes and also provide the framework to be more vigilant of the potential complications in PCOS patients.
In summary, the current work uncovers a worsening cardiometabolic health profile of reproductive age women in the U.S. Urgent public health interventions are needed to better screen and prevent cardiac disease with particular attention to at-risk groups. This work has tremendous implications for reducing the rising maternal mortality rate in the U.S.
Prominent researcher, cardiologist, and mentor of this important study, Dr. Michos comments “Polycystic ovary syndrome (PCOS) is the most common endocrine abnormality of women of reproductive age. PCOS is associated with a number of cardiometabolic abnormalities such as hyperandrogenism, insulin resistance, dyslipidemia, elevated blood pressure, and elevated body mass index. Recent studies have shown that PCOS is associated with future risk of cardiovascular (CV) disease, although whether this is directly causal or mediated through those underlying cardiometabolic and endocrine abnormalities has been debated. Either way, it is important for women with PCOS to be screened for CVD risk factors, treated if risk factors are present, and implement healthy lifestyle changes. Although prior work has focused on longer-term CV complications from PCOS, our current analysis examined acute peripartum CV complications at the time of pregnancy delivery. PCOS is associated with infertility, but our analysis using a large nationally representative U.S. sample showed even after these women become pregnant, they are still at heightened risk of adverse CV complications, including peripartum cardiomyopathy, acute heart failure, and venous thromboembolism. This association of PCOS with these acute cardiovascular complications was independent of preeclampsia/eclampsia risk. Our study stresses on the importance of optimizing the cardiovascular health of women with PCOS before, during, and after pregnancy to prevent adverse cardiovascular complications. We also showed that both PCOS and obesity prevalence was rising over this 17-year period (2002-2019), reflecting other national trends of the declining cardiovascular health of young adults, including reproductive age women. So much work needs to be done to revamp prevention efforts in the U.S. including at the individual, healthcare, societal, and policy levels to reverse these very worrisome trends.”
- Trends, Predictors, and Outcomes of Cardiovascular Complications Associated With Polycystic Ovary Syndrome During Delivery Hospitalizations: A National Inpatient Sample Analysis (2002–2019) Salman Zahid MD , Muhammad Zia Khan MD, MS , Smitha Gowda MD , Nadeen N. Faza MD , Michael C. Honigberg MD, MPP , Arthur (Jason) Vaught MD , Carolyn Guan BA , Anum S. Minhas MD, MHS , and Erin D. Michos MD, MHS firstname.lastname@example.org
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Devesh Rai, MD is cardiology fellow at Rochester General Hospital. His research interest include equity, diversity and inclusion along with outcomes research. He aims to specialize in cardiovascular imaging with a focus on prevention. He is passionate about democratizing cardiovascular education and is faculty member of CardioNerds Academy. Twitter: @DeveshRaiMD