POLYCYSTIC OVARY SYNDROME: ORIGINS AND IMPLICATIONS: Long-term health outcomes in polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a widespread condition, with reported prevalences ranging from 5 to 20% in premenopausal women worldwide. Being a chronic hyperandrogenic condition, cardiovascular risk factors cluster even in young adult women with the syndrome because its pathophysiology also involves dysfunctional adipose tissue, chronic low-grade subclinical inflammation and/or insulin resistance. Recent systematic reviews and meta-analyses of available studies suggest that middle-aged and postmenopausal women with PCOS might present with an increased risk of cardiovascular events, namely myocardial infarction and stroke, when compared with non-hyperandrogenic women from the general population. Hyperandrogenic and metabolic complaints of PCOS also have a negative impact on the mental health of this broad segment of the population. However, obesity played a major role in these associations: when comparing populations matched for weight, the cardiovascular risk of women with PCOS appears to be similar to that of women without this condition, even though postmenopausal patients retain their hyperandrogenic features. Importantly, recent results from a longitudinal prospective cohort study failed to demonstrate increased cardiovascular events during the late reproductive or early postmenopausal period of Caucasian patients with PCOS after 10 years of follow-up, even though cardiovascular risk factors were very frequent in these patients. Hence, current evidence indicates that the long-term prognosis of PCOS is somehow better than that expected from their cardiometabolic associations, which are largely driven by the association of PCOS with obesity. Nevertheless, physicians attending these women must still be aware of the potential health consequences of PCOS during their late reproductive years and beyond menopause, in order to identify and properly manage these high-risk patients.