Date of Defense:
Background: Polycystic ovarian syndrome is a common endocrine disorder associated with a variety of metabolic abnormalities that could predispose PCOS women to cardiovascular disease. It is important to understand if PCOS interventions can reduce the risk of these cardiovascular outcomes.
Objectives: The aim of the review is to study the effect of PCOS treatment interventions on the risk of cardiovascular outcomes of PCOS. Methods: A systematic review of the literature was conducted using PubMed search database for PCOS interventions including metformin, thiaglitazones, anti-androgens, oral contraceptives, diet, anti-obesity drugs, exercise and their combinations. The cardiovascular outcomes considered in this review included clinical outcomes of myocardial infarction, angina pectoris and stroke; the surrogate markers included flow mediated dilation, endothelin-1 and blood pressure.
Results: There are no studies that assessed the effect of PCOS intervention on clinical markers of cardiovascular disease. The studies on surrogate cardiovascular markers have marked heterogeneity and are of limited quality. Flow mediated dilatation increases with PCOS related intervention. The effect of metformin on endothelin -1 is beneficial. The effect of PCOS interventions on the blood pressure is variable. While exercise and diet reduced blood pressure, the effect of metformin and sibutramine is variable and rosiglitazone do not show any significant effect.
Conclusions: There is limited evidence to prove the beneficial effects of PCOS intervention on later cardiovascular disease in PCOS women. Larger high quality studies are required to ascertain the long term and short term adverse cardiovascular outcomes in PCOS women compared to non-PCOS women, and among stratified subgroups of obese and lean PCOS women because the etiology of PCOS may differ by these groups.