Although PCOS often presents in the early reproductive years, it is now recognized that the consequences of PCOS extend beyond the reproductive axis and the reproductive years. Women with PCOS appear to be at substantial risk of developing diabetes and cardiovascular disease. Several studies indicate that the risk of metabolic syndrome in PCOS is approximately 50% in young adulthood. Metabolic syndrome is a constellation of metabolic risk factors that increase the risk of cardiovascular events 2-fold. For women, these include increased abdominal waist circumference (>88 cm), elevated triglycerides (> 150 mg/dL), reduced HDL (<50 mg/ dL), elevated blood pressure (> 130 mm Hg systolic or > 85 mm Hg diastolic or drug treatment for hypertension), and elevated fasting glucose (> 100 mg/dL).
Many women with PCOS develop impaired glucose tolerance or frank diabetes. In studies of obese women with PCOS 30-40% will have previously undiagnosed impaired glucose tolerance and as many as 10% will have frank type 2 diabetes. This increased risk of impaired glucose tolerance and diabetes is also seen in young adolescent women with PCOS who are obese. Therefore assessment of women with diagnosis of PCOS should include an assessment of glucose tolerance. This is best accomplished through the use of an oral glucose tolerance test.
Vascular endothelial dysfunction has been described in women of all ages with PCOS and appears to be associated with insulin resistance. Hypertension may develop during the reproductive years although this has not been consistently demonstrated. Coronary artery calcification and increased carotid intima media thickness has also been shown to be significantly more prevalent in women with PCOS compared to control women.
Several recent studies have associated obstructive sleep apnea with insulin resistance. Increased BMI alone did not show the same association. The prevalence of sleep apnea in women with PCOS is higher than in non-PCOS women and may be linked primarily to increased insulin resistance.
Given the prevalence of increased metabolic abnormalities in women with PCOS, careful attention to assessment of the metabolic state is recommended. This includes assessment of glucose tolerance and lipid profiles even in young women with PCOS particularly if they are obese. Inquiry into symptoms of sleep apnea is also recommended.
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