Will My PCOS Lead To Heart Disease?

A Discourse for the Afro-Caribbean Woman with PCOS

As I sit down to write this blog post, I can’t help but feel a sense of urgency and personal connection to the topic at hand. If you’re nearing 40, you’re marching right into your second puberty or perimenopause; and I’ve become acutely aware of the heightened risk of heart disease that accompanies this stage of life – but even more so, as a black woman, with PCOS.

Did you know that women with PCOS are twice as likely to develop heart disease? It’s a startling statistic. But what about those of us with Caribbean roots? According to this article in the Lancet, “In Latin America and the Caribbean, 31% of all deaths are attributable to cardiovascular disease. In 2000, some 180 000 deaths from cardiovascular disease occurred in adult women aged 15–69 years, making it the leading cause of death in this age group.”

Also, according to the American Heart Association (AHA): “Stroke and heart disease are the leading causes for Black women; cardiovascular diseases account for more than 50,000 deaths annually. Approximately 60% of Black women ages 20 and older have a cardiovascular disease.”

Sobering, huh?

But let’s keep going…

Understanding Heart Disease

Heart disease encompasses a spectrum of conditions affecting the heart and blood vessels, from coronary artery disease to heart failure. It’s a complex interplay of genetics, lifestyle factors, and underlying health conditions.

When it comes to PCOS, several factors contribute to an elevated risk of heart disease. Let me tell you the real reason why we are at such a high risk as succinctly as possible (and then continue reading for a breakdown of all the medical mumbo-jumbo):

Insulin resistance in PCOS occurs when the body’s cells become less responsive to insulin, leading to elevated insulin levels. Insulin resistance promotes inflammation, adversely affects blood vessel function, and contributes to the accumulation of fat around abdominal organs. This visceral adiposity is associated with increased secretion of inflammatory substances and hormones, exacerbating insulin resistance and promoting dyslipidemia. Additionally, androgen excess in PCOS, such as elevated levels of testosterone, can lead to adverse lipid profiles, including higher levels of low-density lipoprotein (LDL) cholesterol and lower levels of high-density lipoprotein (HDL) cholesterol, further increasing cardiovascular risk. The combination of insulin resistance and androgen excess creates a pro-inflammatory and pro-atherogenic environment, increasing the likelihood of developing heart disease over time.
Chantelle T.

Now Let’s break this all the way down

Insulin Resistance and Metabolic Factors

Imagine your body as a bustling city (think Times Square, NYC or Half-Way-Tree, Jamaica pon a Friday evening) and insulin as the traffic police, directing glucose (sugar) into cells for energy. In insulin resistance, it’s like the traffic police’s signals aren’t as effective anymore, leading to a traffic jam of glucose in your bloodstream. This chaos triggers inflammation, like angry protests in the streets. Additionally, insulin resistance disrupts the normal functioning of blood vessels, making them less efficient at delivering oxygen and nutrients to tissues, like blocked roads causing delays. Meanwhile, the excess glucose gets diverted to your abdominal area, much like excess construction materials piling up in a busy downtown. This creates a dangerous environment, with more inflammation and hormonal chaos, further worsening the traffic jam. Ultimately, it’s like a perfect storm, increasing the risk of heart disease down the road.

Hormonal and Inflammatory Factors

Androgens are hormones that can sometimes go into overdrive, like a party guest who’s a little too enthusiastic. In PCOS, these androgens, like testosterone, throw the body’s cholesterol levels off balance. It’s like having too much of the “bad” cholesterol (LDL) and not enough of the “good” kind (HDL), causing a sort of imbalance in your body’s “cholesterol party”. This imbalance isn’t just about numbers; it sets the stage for heart problems. When you add this hormonal imbalance to the mix of insulin resistance we talked about earlier, it’s like adding fuel to the fire. Together, they create a situation where inflammation runs high, and your arteries become more prone to getting clogged up over time, like a highway with too much traffic and not enough lanes. And that’s a recipe for heart disease down the road.

Additionally, chronic low-grade inflammation, commonly observed in PCOS, may exacerbate endothelial dysfunction (i.e. worsen the health of your blood vessel linings) and contribute to the progression of atherosclerosis (i.e. speeding up the hardening of your arteries).

EAT-MOVE-REST Lifestyle Strategies for Heart Health

Now, let’s pivot to practical strategies for mitigating cardiovascular risk in the context of PCOS. While genetic predispositions are beyond our control, lifestyle modifications can significantly influence heart health outcomes:

EAT A Balanced Diet – Adopt a diet rich in fruits, vegetables, complex starch, lean proteins, and healthy fats. Emphasize fiber-rich foods and limit processed foods, sugary beverages, and excessive sodium intake.

MOVE Regularly and Intentionally – Engage in aerobic exercise most days of the week, aiming for at least 150 minutes of moderate-intensity activity or 75 minutes of vigorous-intensity activity.

REST from Stress – Incorporate stress-reduction techniques such as mindfulness meditation, deep breathing exercises, yoga, or progressive muscle relaxation into your daily routine.

Clinical Monitoring and Screening:

For individuals with PCOS, proactive clinical monitoring and screening are important for early detection and management of cardiovascular risk factors. Think of it like checking your car’s engine regularly to catch any issues before they become major problems. Key tests to consider include lipid panel assessments (LDL cholesterol, HDL cholesterol, triglycerides), blood pressure measurements, fasting glucose levels, and periodic assessments of HbA1c. Consult with your healthcare provider to establish personalized screening protocols tailored to your individual health profile.

Here’s the lowdown: while there’s no one-size-fits-all approach for screening heart disease in PCOS, there are some important steps you can take. One study suggests that once women with a history of PCOS hits their 30s, it’s a good idea to start thinking about more detailed heart screenings, like checking the thickness of your carotid arteries to spot any early signs of trouble. And by the time you hit 45, it might be time for a closer look at your heart’s calcium levels to assess your risk of heart disease.

If any red flags pop up during these screenings – like high cholesterol or blood pressure – there are plenty of ways to tackle them head-on.

I hope this was helpful! Wishing you a heart-healthy journey ahead!

References

Alexander CJ, Tangchitnob EP, Lepor NE. Polycystic ovary syndrome: a major unrecognized cardiovascular risk factor in women. Rev Obstet Gynecol. 2009 Fall;2(4):232-9. PMID: 20111659; PMCID: PMC2812885. URL: https://pubmed.ncbi.nlm.nih.gov/20111659/
Wild, R. A., Carmina, E., Diamanti-Kandarakis, E., Dokras, A., Escobar-Morreale, H. F., Futterweit, W., … & Dumesic, D. A. (2010). Assessment of cardiovascular risk and prevention of cardiovascular disease in women with the polycystic ovary syndrome: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society. The Journal of Clinical Endocrinology & Metabolism, 95(5), 2038-2049.
Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. (2004). Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Human reproduction, 19(1), 41-47.
Ding, D. C., Tsai, I. J., Wang, J. H., Lin, S. Z., & Sung, M. C. (2012). Risk of cardiovascular disease in women with polycystic ovary syndrome: a systematic review and meta-analysis. Reproductive Biomedicine Online, 25(1), 9-23.
Shah, D. K., Missmer, S. A., & Berry, K. F. (2011). Racism and disparities in women’s health. Journal of Women’s Health, 20(9), 1453-1454.
Foy, M., & Ramsay, M. (2013). Carotid intima-media thickness: an assessment of the evidence that this measure is both a marker and a cause of atherosclerosis. Oxford University Press.
Budoff, M. J., Hokanson, J. E., Nasir, K., Shaw, L. J., Kinney, G. L., Chow, D., … & Raggi, P. (2010). Progression of coronary artery calcium predicts all-cause mortality. JACC: Cardiovascular Imaging, 3(12), 1229-1236.
American Heart Association. (2020). Lifestyle Changes for Heart Attack Prevention. Retrieved from: https://www.heart.org/en/health-topics/heart-attack/lifestyle-changes-for-heart-attack-prevention.