Polyendocrine metabolic ovarian syndrome is associated with a higher risk of cardiovascular events

The study provides robust evidence based on a substantial sample size and confirms a previously documented association whereby PCOS, now referred to as PMOS, is linked to an increased cardiovascular risk through its association with diabetes, obesity, and hormonal disorders. This study strengthens the existing evidence, with the association remaining significant even after adjustment for recorded cardiovascular risk factors. However, by design, it is not a study that can establish causality, nor does it allow us to conclude that the residual risk is necessarily attributable to biological mechanisms intrinsic to the syndrome itself, although in my view the findings do point in that direction.

The study reinforces the importance of early assessment of cardiometabolic risk factors in these women and highlights the need for targeted preventive strategies to reduce cardiovascular events. In particular, attention should be given to maintaining a healthy diet, preventing obesity, and encouraging regular physical activity, although these measures are, of course, advisable for everyone.

The era of big data continues to bear fruit in biomedical research and, in particular, in women’s health. The analysis of large volumes of clinical data makes it possible to study, in a short space of time, certain aspects of diseases that would otherwise require years of research. This helps us to better understand the context in which they develop and, consequently, to improve their prevention, diagnosis and treatment. This is the case with the study now being published on polycystic ovary syndrome, recently renamed ‘polyeendocrine metabolic ovarian syndrome’ to more accurately reflect the negative impact that this hormonal imbalance has on the body’s overall functioning, and not just on the ovaries. Previous studies had already shown that women of reproductive age with this syndrome are more likely to have cardiovascular risk factors, such as diabetes, dyslipidaemia, obesity or hypertension. However, there were no conclusive data on the risk of developing atherosclerotic cardiovascular disease, characterised by a progressive thickening and hardening of the inner walls of the arteries, which increases the likelihood of suffering cardiovascular events such as a heart attack, angina or a stroke.

In this longitudinal study, based on a retrospective analysis of a US national database, a comparison between more than 400,000 women with polyendocrine metabolic ovarian syndrome and others without this condition provides strong evidence of an increased risk of atherosclerotic cardiovascular disease in affected patients. As the authors point out, these results once again highlight the need both to train healthcare professionals and to empower patients in the area of prevention, through the adoption and maintenance of healthy lifestyles as the first line of action. In other words, it is essential to design and implement early preventive interventions through public health policies to reduce long-term cardiovascular risk. In fact, as early as 2023, an international recommendation was published that included the clinical assessment of cardiovascular risk from the time of diagnosis of polyendocrine metabolic ovarian syndrome; however, as the authors highlight, the effective translation of this evidence into clinical practice remains limited.

It should be borne in mind that all scientific research has its limitations. Among these is the need for caution when generalising these results to other populations, as the socio-health context and the prevalence of cardiovascular risk factors can vary considerably between countries and even between different regions.

Furthermore, following this advance in our understanding of the cardiometabolic context of polyendocrine metabolic ovarian syndrome, future research should examine how this risk varies across the different clinical forms of the condition, what influence standard treatments such as hormonal contraceptives and metformin have, and what occurs at other stages of women’s lives, such as the menopause.

I believe this is an important study, particularly given the large number of women included and the duration of the follow-up. The results reinforce the idea that SOMP is not merely a problem related to menstruation, fertility or the ovaries, but a condition with metabolic and cardiovascular implications. The increased risk they have identified is striking and remains even after taking into account factors such as obesity, high blood pressure, diabetes and high cholesterol.

Nevertheless, it must be interpreted with some caution. As this is a study based on administrative records, there may be errors in the identification of certain diagnoses, and it does not allow a causal relationship to be demonstrated. Furthermore, although the relative risk increases significantly, the absolute risk in young women remains low. In practice, the message should not be to cause alarm, but rather to emphasise that these women require metabolic and cardiovascular assessment from the time of diagnosis and long-term follow-up. The new name, SOMP, fits well with this broader view of the syndrome, although it should not make us forget that this is a highly heterogeneous condition.