We have all had those moments when we are convinced that there is something wrong with our heart and most of the time it turns out to be trapped wind or indigestion or some other trivial gastro problem. I bet you didn’t know that women PCOS are at higher risk of developing heart disease and diabetes than women without PCOS. I have never understood why doctors are so transfixed on solving the absent period problem or the facial hair dilemma than the actually problematic and deadly symptoms of PCOS. Not once when I was under the guidance of a doctor or consultant did they inform me that my cardiovascular health was at risk or that I was 3 times more likely to have heart disease later in life due to this illness. I was never warned about the effects of insulin resistance on my body and the increased risk of developing diabetes by the time I hit menopause. All the serious complications that accompany PCOS where left untold and somewhat forgotten. Instead, I was told take birth control, have ovarian drilling or even have more sex. Is it because I am a woman? Do doctors automatically assume we only care about reproduction? Well, not this cyster I am more concerned with the fact that my biological father had a heart attack before the age of 50 and that alone puts me in a higher risk category. Doctors need to do more to promote the fact that PCOS is not a reproductive disorder but an endocrine disorder that affects many of the major systems that keep you up and walking around.
PCOS And Heart Disease: What is the connection?
PCOS and heart disease have many common risk factors. These include obesity, insulin resistant, diabetes, hypertension, and metabolic syndrome. A lot of women with PCOS also have plaque build-up in their arteries which reduces blood flow to the heart and can cause coronary artery disease. The congestion in the arteries alone is a major risk for heart disease.
Insulin resistance is a condition whereby the body cannot process insulin correctly and tries to correct itself by overproducing insulin. This excess of insulin cause problems in the body, the liver will convert excess insulin to fat and insulin is also a trigger for androgen production. Almost 80% of women with PCOS are insulin resistant and this climbs up to a massive 95% if the woman is obese. All this free-floating insulin can lead to type 2 diabetes and guess what? type 2 diabetes is a major player in the development of heart disease.
Metabolic syndrome is not an illness but a collection of health markers. Metabolic syndrome presents with insulin resistance, central obesity, hypertension, hyper cholesterol and a waist circumference of 35in or more. Women with Metabolic Syndrome are at higher risk for the development of diabetes and cardiovascular disease including heart attack and stroke.
This syndrome is the main cause of chronic inflammation around the body; this inflammation can also contribute to the build-up of plaque in the arteries.
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.
PCOS And Heart Disease: Are Some Women At A Higher Risk
The American Heart Association classifies women at risk of heart disease as 1) optimal risk, 2) at risk, or 3) at high risk. PCOS women are classified into two categories:
- At risk
PCOS women with the following health conditions are at risk of heart disease:
- Obesity (especially increased abdominal obesity)
- Cigarette smoking
- Dyslipidemia (abnormal amount of lipids in the blood)
- Atherosclerosis (hardening and narrowing of arteries)
- Insulin resistance
- A family history of premature heart disease
- At high risk
PCOS women with the following conditions are a higher risk of heart disease:
- Metabolic syndrome
- Type 2 diabetes
- Vascular or renal disease
Prevention Of Risk Of PCOS And Heart Disease Through Medication
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.
In the UK the main drug prescribed for obesity is called Orlistat. This medication works by preventing some of the fat from the food you eat from being absorbed. The undigested fat isn’t absorbed into your body and is passed when you go to the toilet.
Tips To Reduce The Risk Of PCOS And Heart Disease
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 bread, 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.