Dec 30, 2010

Polycystic Ovary Syndrome Ups Young Women’s Diabetes Risk

NEW YORK (Reuters Health) – Even when they are young, women with polycystic ovary syndrome (PCOS) are at increased risk of diabetes and high cholesterol, new research shows.

“Young women in their 20s, physicians usually don’t consider them to be a target group to be followed closely,” one of the study’s authors, Dr. Erica T. Wang of the University of California, San Francisco, told Reuters Health. “Our study suggests we do need to recognize young women who have PCOS and follow them more closely.”

Given that this increased risk also persisted for years even in women whose PCOS symptoms resolved, the findings underscore the importance of maintaining a healthy lifestyle over the long-term, Dr. R. Jeffrey Chang of the University of California, San Diego, notes in an editorial accompanying the study.

PCOS occurs in 5% to 10% of reproductive-age women, according to the National Women’s Health Information Center. Their abnormally high androgen levels can lead to infertility, irregular menstruation, excessive hair growth, and ovarian cysts, along with weight gain, especially around the waist.

Beyond diet and exercise, PCOS may be treated with insulin-lowering drugs and sometimes with hormonal therapies, such as birth control pills or androgen-lowering drugs.

Studies have linked PCOS to several risk factors for heart disease, such as obesity and high blood pressure, as well as diabetes. But it’s still not clear whether PCOS, itself, is responsible, Dr. Wang and her colleagues write in the January issue of Obstetrics & Gynecology (available online this month).

To investigate, the authors looked at 1,127 women participating in the Coronary Artery Risk Development in Young Adults study, a long-term investigation of heart disease risk factors among whites and African-Americans in four U.S. cities.

The women ranged in age from 20 to 32 at the beginning of the study, and were followed for 18 years.

Fifty-three of the women had PCOS at the beginning of the study. A dozen of them had developed type 2 diabetes by the end of the follow-up period and 18 had dyslipidemia. On multivariate analysis, after adjustment for potential confounding variables (including weight), those rates translated to about twice the risk for both diabetes and high cholesterol in women with PCOS vs those without it.

The researchers also analyzed the risks for 31 normal-weight women with PCOS at the study’s outset. These women were found to be at triple the risk of type 2 diabetes compared to normal-weight women without the syndrome.

At year 14 of the study, 746 of the original study participants were assessed for PCOS a second time. Fifteen of the women still had it. These women with “persistent” PCOS had a more than seven-fold greater risk of developing type 2 diabetes during the subsequent five years.

The fact that PCOS symptoms disappeared in many of the women over time suggests that the syndrome becomes less common with age, as other studies have found, Dr. Chang notes in his editorial. Given that these women were still at increased risk of diabetes, despite no longer having PCOS, the findings also suggest that excess male hormone secretion may not be the main cause of increased diabetes risk, he adds.

“Thus, continued emphasis on lifestyle and behavior modification is imperative in women affected by this disorder,” he concludes.

Obstet Gynecol. Posted January 2011.

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