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Women with PCOS are at a very high risk of heart disease. Medical therapy deals only with individual risk factors of PCOS and heart disease in women. Holistic lifestyle changes are by far the most important, safe and effective way of reducing these risks.
A study of 104 post-menopausal women with PCOS showed that the condition leads to a large number of cardiovascular events. Other studies have also shown a strong correlation between PCOS and the increased risk of heart disease. Let’s find out how PCOS and heart disease are linked and tips to address their common risk factors.
Both PCOS and heart disease have several risk factors in common. These risk factors include obesity, impaired glucose metabolism, diabetes, hypertension and metabolic syndrome. A majority of women with PCOS also have atherosclerosis (deposition of plaques in the blood vessels that impede blood flow). This condition in itself is a major risk factor for heart disease.
Insulin resistance is seen in almost 80% of women with PCOS. This figure climbs to a whopping 95% if a woman is obese. It is apparent that insulin resistance, if unaddressed for long, may lead to type 2 diabetes. And type 2 diabetes is a major risk factor for the development of heart disease.
Women with PCOS also suffer from metabolic syndrome (MS), which is characterized by:
Metabolic syndrome usually causes a chronic type of inflammation that can lead to atherosclerosis, which is a major risk factor for heart disease.
Women with PCOS are also prone to mood disturbances and depression. Research shows that these are independent risk factors for heart disease. Depression in women with PCOS is both psychological as well as physiological. It may lead to fatigue, sleep disturbances, phobia, changes in appetite and binge eating. As a result, women with PCOS gain weight easily. Obesity increases the chances of insulin resistance and eventually of heart disease.
The American Heart Association classifies women at a risk of heart disease as 1) optimal risk, 2) at risk, or 3) at high risk. PCOS women are classified into two categories:.
PCOS women with the following health conditions are at a risk of heart disease:
PCOS women with the following conditions are a higher risk of heart disease:
Medical therapy aims to reduce the combined risk of PCOS and heart disease in women by reducing individual risk factors. Thus, medical therapies can be put into different categories depending on the risk factor they are addressing.
Metformin has long been used in women with PCOS and it does show some effects on body weight. It may improve dyslipidemia and atherosclerosis. Its primary objective is to reduce insulin resistance. Data suggests (from small studies) that to some extent it can also help women with PCOS in reverting to normal glucose tolerance.
Cholesterol-lowering drugs should only be given to those women with PCOS who have increased blood levels of LDL-C (a type of “bad” cholesterol). Statins can successfully control cholesterol levels in women with PCOS. They are, however, not without their side effects. These include liver damage, severe muscle inflammation, and depletion of vital nutrients like vitamin K2 and coenzyme Q10.
Even milder forms of hypertension (elevated blood pressure) increase the risk of heart disease. Therefore, reducing blood pressure is vital for the long-term prevention of heart disease. Doctors often recommend multiple drugs for lowering blood pressure. Among others, these drugs include diuretics and beta blockers. These drugs come with certain side effects that you need to be aware of.
The US FDA has approved 5 drugs for obesity treatment. These include orlistat, phentermine, lorcaserin, naltrexone, and liraglutide. These drugs can show a less than 10% reduction in weight in the long term. In some cases, this isn’t adequate for women with PCOS.
Doctors believe that lifestyle modifications should be the first line of therapy for reducing risks of complications in PCOS and for the treatment of PCOS itself. Guidelines published in the European Heart Journal emphasize the importance of lifestyle modifications including diet, exercise, stopping smoking, and stress management in reducing the risks of PCOS and heart disease. Even short-term weight loss can decrease fat deposits around the abdomen, which in turn can reduce male hormone levels and insulin resistance. It can also reduce dyslipidemia and depression, thereby improving the quality of life.
Experts also recommend a diet that is rich in fibers, whole-grain breads, cereals, fruits, and vegetables. A 30-minute moderate-intensity physical exercise regime is also recommended to maintain weight. The combination of diet and exercise can go a long way in addressing the common risk factors for PCOS and heart disease.