LETTER
Polycystic Ovaries and Coronary Artery Disease
Nancy M. McBride, MD
15 September 1997 | Volume 127 Issue 6 | Page 491
TO THE EDITOR:
Birdsall and colleagues [1] recently discussed the association of polycystic ovaries and the extent of coronary artery disease in women having cardiac catheterization. They stated that anovulation with reduced estradiol production may be associated with coronary artery disease. However, elevated testosterone production seems to be one of the atherogenic influences in polycystic ovaries. As shown in their Table 2, the free testosterone values in women with polycystic ovaries were significantly greater than those in women with normal ovaries. This finding would also explain the diminished high-density lipoprotein cholesterol values found in women with polycystic ovaries. Estradiol levels were not measured during the study or addressed in the review of patients. Many women with polycystic ovaries exceed their ideal body weight and therefore tend to have normal circulating levels of estrogen, often as estrone [2, 3].
I wholeheartedly agree with Birdsall and colleagues' suggestion that further studies must be undertaken to investigate the natural history and current treatments for polycystic ovaries-not only to alleviate the physical symptoms of androgen excess (which are devastating to many women) but also to reduce the occurrence of long-term complications and even death.
Polycystic ovaries may be one variant of syndrome X-just the "female influence." If so, we should evaluate the influence of pregnancies and use of oral contraceptives on the risk for developing cardiac disease. The role of insulin resistance and the association of polycystic ovaries independent of androgen excess is another possible atherogenic risk factor in these women [4, 5].
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Author and Article Information
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Lakewood, OH 44107
1. Birdsall MA, Farquhar CM, White HD. Association between polycystic ovaries and extent of coronary artery disease in women having cardiac catheterization. Ann Intern Med. 1997; 126:32-5.
2. Polson DW, Adams J, Wadsworth J, Franks S. Polycystic ovaries-a common finding in normal women. Lancet. 1988; 1:870-2.
3. Polson DW, Franks S, Reed MJ, Cheng RW, Adams J, James VH. The distribution of oestradiol in plasma in relation to uterine cross-sectional area in women with polycystic or multifollicular ovaries. Clin Endocrinol (Oxf). 1987; 26:581-8.
4. Poretsky L. On the paradox of insulin-induced hyperandrogenism in insulin-resistant states. Endocr Rev. 1991; 12:3-13.
5. Geffner ME, Kaplan SA, Bersch N, Golde DW, Landaw EW, Chang RZ. Persistence of insulin resistance in polycystic ovarian disease after inhibition of ovarian steroid secretion. Fertil Steril. 1986; 45:327-33.
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