PCOS and irregular cycles tied to cardiometabolic risks

There is a potential association of polycystic ovary syndrome (PCOS) and irregular cycles with cardiometabolic conditions, according to a recent study in JAMA Network Open.¹

Associations have been identified between irregular menstrual cycles and adverse health outcomes. PCOS, an ovulatory disorder presenting as irregular cycles and hyperandrogenism, is experienced by 8% to 13% of reproductive-aged women.

The disorder has been linked to cardiometabolic conditions such as coronary heart disease and stroke. According to the Centers for Disease Control and Prevention, patients with PCOS also have increased risks of diabetes, high blood pressure, and sleep apnea.²

However, it is unclear whether data linking PCOS to cardiometabolic risk were influenced by other etiologies that could lead to increased risks.¹ Many studies about this association also had relatively homogeneous or hospital-based populations.

To evaluate the association between PCOs and irregular cycles with cardiometabolic conditions, investigators conducted a cross-sectional study. US participants using the iPhone Apple Research application aged 18 years or older and able to speak English were included in the trial.

Demographic, medical history, reproductive history, hormonal symptom, and general health and lifestyle data was obtained from 5 surveys completed by participants following enrollment. Participants who enrolled between November 14, 2019, and December 13, 2022, with a completed demographic and at least 1 other survey were eligible for analysis.

PCOS status was determined by physician diagnosis, and cycle regularity by the survey question, “After your first menstrual cycle, how long did it take for your cycle to become regular?” Irregular cycles were determined by self-reported unpredictable periods.

Data about physician diagnosed cardiometabolic conditions was also collected, including prediabetes, type 1 diabetes, type 2 diabetes, hypertension, arrhythmia, high cholesterol, coronary artery disease (CAD), congestive heart failure, heart valve disease, stroke, heart attack, transient ischemic attack (TIA), deep vein thrombosis (DVT), and pulmonary embolism.

Covariates included race and ethnicity, age, employment status, education, socioeconomic status, self-perceived social rank, body mass index (BMI), age at menarche, history of hormone use, and family history of diabetes, high cholesterol, obesity, and hypertension.

There were 60,789 participants aged a mean 34.5 years included in the final analysis, aged a mean 34.5 years. Of participants, 71.4% were non-Hispanic White, 10.1% multiracial, 7.3% Hispanic, 5.4% non-Hispanic Black, 3.2% Asian, and 2.6% other race. Employment was reported in 72% and at least some college education in 82.9%.

Prolonged time to regularity was reported among 26.3% of participants, PCOS among 12.3%, and irregular cycles among 25.6%. Patients with PCOS had a lower socioeconomic status and gravidity and higher hormone use, BMI, cardiometabolic condition prevalence, and family history of metabolic conditions than those without PCOS.

An association was reported for longer time to regularity with PCOS and irregular cycles, with prevalence odds ratios (PORs) of 3.53 and 1.96, respectively. In patients with longer time to regularity but without PCOS, the POR for irregular cycles was 2.66.

Associations were identified between PCOS and each cardiometabolic condition. The PORs for obesity, prediabetes, type 1 diabetes, type 2 diabetes, high cholesterol, hypertension, and metabolic syndrome were 2.94, 3.75, 1.43, 2.76, 1.68, 1.57, and 3.28, respectively.

For cardiovascular conditions, PCOS had a POR of 1.37 for arrhythmia, 2.92 for CAD, 1.79 for heart attack, 1.66 for stroke, 1.87 for TIA, 1.54 for DVT, and 1.83 for pulmonary embolism. Risks of type 1 diabetes, type 2 diabetes, hypertension, arrythmia, and TIA were also found among patients without PCOS but with prolonged time to regularity.

Irregular cycles were also associated with obesity, prediabetes, type 2 diabetes, high cholesterol, hypertension, metabolic syndrome, arrythmia, heart attack, and TIA, with PORs of 1.38, 1.78, 1.38, 1.29, 1.20, 1.73, 1.21, 1.80, and 1.53, respectively.

These results indicated positive associations between PCOS and irregular cycles with cardiometabolic conditions. Investigators concluded there may be benefits to earlier screening and intervention regardless of PCOS status.

Reference

1. Wang Z, Jukic AMZ, Baird DD, et al. Irregular cycles, ovulatory disorders, and cardiometabolic conditions in a US-based digital cohort. JAMA Netw Open. 2024;7(5):e249657. doi:10.1001/jamanetworkopen.2024.9657
2. PCOS (polycystic ovary syndrome) and diabetes. Centers for Disease Control and Prevention. Accessed May 15, 2024. https://www.cdc.gov/diabetes/basics/pcos.html