July 28, 2017
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PCOS increases risk for stroke, not all-cause death

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Women with polycystic ovary syndrome have a 36% increased risk for experiencing stroke vs. women without the condition, but they are not at increased risk for all-cause mortality, according to a meta-analysis published in Gynecological Endocrinology.

“It has generally been assumed that PCOS women have a higher risk of stroke and all-cause mortality because they have many of the risk factors,” Yaqiong Zhou, MD, of the department of cardiology at the First Affiliated Hospital of Xi’an Jiaotong University, China, and colleagues wrote. “The past few years have witnessed a rapidly growing interest in testing this hypothesis, [and] many epidemiologic literatures have investigated the link between PCOS and long-term stroke risk and all-cause mortality, but the results are surprisingly conflicting.”

Zhou and colleagues analyzed data from five retrospective cohort studies and four prospective cohort studies involving 237,647 adults with and without PCOS, conducted through November 2016. Average follow-up duration ranged from 4.7 to 40 years; patients were followed for at least 10 years in 89% of studies. Four studies recruited at least 10,000 participants; the endpoint of stroke was reported in eight studies; all-cause mortality was reported in five studies.

Researchers found that women with PCOS had an increased risk for stroke vs. those without PCOS (OR = 1.36; 95% CI, 1.09-1.7). Researchers also observed an increased risk for all-cause death that did not rise to statistical significance (OR = 1.21; 95% CI, 0.91-1.6).

In subgroup analyses, researchers found an association between stroke and PCOS in women younger than 50 years (OR = 1.31; 95% CI, 1.04-1.65).

After pooling the five studies with risk estimates adjusted for BMI, the association between PCOS and stroke was slightly attenuated, the researchers noted; however, the OR did not reach statistical significance (OR = 1.24; 95% CI, 0.98-1.59).

“Increased BMI was not the sole cause of the increased risk for stroke,” the researchers wrote. “Further study is needed to clarify which subgroups of subjects with the PCOS are at higher risk for stroke and should focus on understanding the exact mechanisms for cerebrovascular risk, on developing reliable device for risk stratification, and ultimately on exploring strategies to prevent stroke in subjects with PCOS. In the interim, it is reasonable to aggressively screen patients with PCOS for stroke risk factors and initiate risk mitigation treatments (lifestyle, antihypertensive, and blood-lipids regulator drugs, etc) in a timely fashion.” – by Regina Schaffer

Disclosures: The authors report no relevant financial disclosures.