CARDIOLOGY


higher risk of developing cardiovascular risk compared to their peers without PCOS. Women in their 30s and 40s with PCOS were at greater risk of cardiovascular disease compared to those without PCOS. The evidence in those under 30 was less clear; this is likely because there were insufficient women of that age in the dataset to identify the risk. Dr. Oliver-Williams said: “Heart health appears to be a particular problem for young women with PCOS. This may be because they are more likely to be overweight and have high blood pressure and diabetes compared to their peers. Previous studies have suggested that these differences diminish with age. In other words, as women without PCOS get older, they increasingly become overweight and develop high blood pressure and diabetes. In a negative sense, they catch up to their peers with PCOS.” She encouraged young women with PCOS to stay positive: “PCOS can be a distressing condition. Not just because it can affect fertility. The physical effects can cause anxiety and depression. There’s so much pressure on young women to achieve what we’re told is the physical ideal. It takes age and time to embrace yourself and getting support from others is a vital step, so reach out if you need it.”


“Knowledge is power and being aware of the heart risks means women with PCOS can do something about it,” said Dr. Oliver- Williams. “Women with PCOS have been dealt a tough hand but this is about how these women play their cards. There are fantastic PCOS support groups where they can find out what has helped others with PCOS lose weight, get more exercise, and have a healthier diet.”


She noted that the study only included Scandinavian women taking fertility treatment and caution is needed when extending the findings to other groups.


Polycystic ovaries Research presented at ESC Congress also provided hope for young women after heart attack.8


During a median follow-up of 20 years,


the primary composite endpoint occurred in 25.7% of women compared to 37.0% of men (hazard ratio [HR] 0.69; 95% confidence interval [CI] 0.52–0.91; p=0.01). When the components of the primary endpoint were analysed separately, the researchers found that second heart attacks were less frequent in women compared to men (14.2% vs. 25.4%; HR 0.53; 95% CI 0.37–0.77; p<0.001). However, women were more likely to have a stroke compared to men (7.7% vs. 3.7%; HR: 2.02; 95% CI 1.17–3.49; p=0.012).


Previous research has shown that women are more likely to die after a heart attack than men. However, the Italian Genetic Study on Early-onset Myocardial Infarction showed that this does not hold true before the menopause, when women are still exposed to oestrogen, a hormone that protects against heart disease.9 The study compared outcomes of women and men under 45 who had a heart attack. The study included 2,000 patients (1,778 men and 222 women) who presented to hospital with a heart attack before the age of 45 at 125 Italian coronary care units between 1998 and 2002. The primary endpoint was a composite of recurrent heart attack, stroke, or death from cardiovascular disease.


Smoking (46.5% vs. 42.8%), alcohol consumption (65.3% vs. 27.4%), high blood lipids (62.3% vs. 50.7%) and diabetes (7.8% vs. 5.4%) were more frequent in men compared to women (all p<0.001). Principal investigator, Professor Diego Ardissino of Parma University Hospital, Italy, said the better prognosis in premenopausal women compared to men was likely related to different mechanisms behind the heart attacks. Women were more than twice as likely to have healthy arteries than men (36.5% vs. 15.4%; p<0.001), but coronary artery dissection (a tear in a blood vessel supplying the heart) was more frequent in women (5.4% vs. 0.7%; p<0.01). He commented: “In men, coronary events were mostly due to blocked arteries, while in women they had other causes such as coronary dissection which is known to have a more favourable prognosis and a lower risk of recurrence.”


At discharge from hospital, men were more likely than women to be prescribed medications to protect against second heart attacks, including beta-blockers, aspirin, and angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs). The likelihood of statin treatment was similar in men and women. Professor Ardissino added: “The disparity in prescribing may be due to the lower


26 l WWW.CLINICALSERVICESJOURNAL.COM


burden of coronary artery disease found in women in the study. It could also relate to the general under-prescribing of medication for women compared to men seen in other studies of acute cardiac events… In contrast to the prevailing literature, women experiencing an early-onset heart attack have favourable long-term outcomes compared to men, despite being prescribed fewer preventive medications.” Further information and research findings can be accessed at: https://www.escardio. org/Congresses-&-Events/ESC-Congress CSJ


References 1 Abstract title: Impact of influenza and pneumococcal vaccines upon in-hospital mortality in patients with heart failure: a retrospective cohort study in the United States.


2 Ponikowski P, Anker SD, AlHabib KF, et al. Heart failure: preventing disease and death worldwide. ESC Heart Fail. 2014;1:4–25.


3 Abstract title: Human genetic determinants of the gut microbiome and their associations with health and disease: A phenome-wide association study.


4 Abstract title: Non-psychotic mental disorders in adolescent men and risk of myocardial infarction: A national cohort study.


5 Abstract title: The association between napping and the risk of cardiovascular disease and all-cause mortality: a systematic review and dose-response meta-analysis.


6 Oliver-Williams C, Vassard D, Pinborg A, Schmidt L. Risk of cardiovascular disease for women with polycystic ovary syndrome: results from a national Danish registry cohort study. Eur J Prev Cardiol. 2020. doi:10.1177/2047487320939674.


7 Jayasena CN, Franks S. The Management of Patients With Polycystic Ovary Syndrome. Nat Rev Endocrinol. 2014;10:624–636.


8 Abstract title: Sex-related differences in long-term outcomes after early-onset myocardial infarction.


9 Hochman JS, Tamis JE, Thompson TD, et al. Sex, clinical presentation, and outcome in patients with acute coronary syndromes. N Engl J Med. 1999;341:226–232.


NOVEMBER 2020


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