Clinical Profiles and CVD Risk in Chinese Women with PCOS Phenotypes

Overview

This cross-sectional study of 206 Chinese women with PCOS classified into four phenotypes found that phenotypes A, B, and C exhibited significantly higher cardiovascular disease (CVD) risk scores compared to phenotype D. Body mass index (BMI), insulin resistance (HOMA-IR), and uric acid (UA) mediated the relationship between PCOS phenotypes and CVD risk, with BMI showing the largest mediating effect.

Background

Polycystic ovary syndrome (PCOS) is a common endocrine disorder in reproductive-aged women, characterized by menstrual irregularities and hyperandrogenism. Beyond reproductive symptoms, PCOS is associated with metabolic abnormalities such as insulin resistance, obesity, and dyslipidemia, which increase cardiovascular disease risk. While CVD risk varies among PCOS phenotypes, data specifically in Chinese women remain limited. This study aimed to characterize clinical profiles and estimate CVD risk across PCOS phenotypes using the China-PAR model.

Data Highlights

Key Findings

• Phenotypes A, B, and C showed significantly higher BMI, waist circumference, systolic and diastolic blood pressure compared to phenotype D (P<0.05).
• Serum uric acid, LDL cholesterol, triglycerides, and insulin resistance (HOMA-IR) were elevated in phenotypes A and B versus D, while HDL cholesterol and insulin sensitivity (ISI-Matsuda) were reduced (P<0.05).
• Lifetime cardiovascular disease risk scores were significantly higher in phenotypes A (15.55%), B (17.65%), and C (17.30%) compared to D (9.90%) (P<0.05).
• After adjustment for lifestyle and medication factors, phenotypes A, B, and C had increased odds of high lifetime CVD risk compared to D, with odds ratios of 3.18, 4.90, and 4.67 respectively (all P<0.05).
• Body mass index, insulin resistance (HOMA-IR), and uric acid significantly mediated the association between PCOS phenotypes and CVD risk, with BMI accounting for the largest mediating effect (up to 94.7% in phenotype A).

Clinical Implications

Regular cardiovascular risk assessment should be considered in women with PCOS, especially those with phenotypes A, B, and C, who demonstrate higher metabolic abnormalities and CVD risk. Clinical management should prioritize weight control and metabolic interventions targeting insulin resistance and uric acid levels to mitigate cardiovascular risk in these patients.

Conclusion

This study highlights distinct clinical and cardiovascular risk profiles among PCOS phenotypes in Chinese women, with phenotypes A, B, and C exhibiting greater risk mediated largely by BMI and metabolic factors. Tailored screening and individualized treatment focusing on weight and metabolic health are warranted to reduce long-term cardiovascular complications.

Related Resources & Content

1. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group 2004 -- Revised 2003 consensus on diagnostic criteria and long-term health risks related to PCOS
2. Amiri et al. 2020 -- Framingham Risk Score in Iranian women with PCOS
3. Zeng et al. 2023 -- China-PAR risk model application in Chinese women with PCOS