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Women with PCOS are at a higher risk of developing cardiovascular disease. Why? And what can you do about it?

If you have PCOS, you already have a lot to consider to maintain optimal health — but did you know that polycystic ovary syndrome also leads to a significantly increased risk of heart disease, according to research? You do now, and the next thing to look at is who's at the highest risk, and what you can personally do to lower your risk of cardiovascular disease.

1. What exactly is cardiovascular disease?

Cardiovascular disease — or more simply put, heart and vessel disease — refers to any disease that negatively affects the heart or the blood vessels. Numerous different conditions fall under this umbrella term, including high blood pressure, heart disease, heart failure, heart attack, and stroke. Atherosclerosis, a process of plaque build-up within the walls the arteries, is connected to a lot of these conditions. 

2. Why are women of PCOS at risk of heart disease?

Women who suffer from PCOS are known to have an increased risk of heart disease, and one that goes up as they get older — but why is this? PCOS and heart disease share some of the very same risk factors, things like impaired glucose tolerance, high blood pressure, and diabetes. That partially explains why PCOS patients are more likely to fall victim to heart disease, but there's more.

As many as eight in 10 PCOS patients are insulin resistant. If you are obese and have PCOS, meanwhile, it's almost impossible not to have insulin resistance — research shows 95 percent of obese women with polycystic ovary syndrome are insulin resistant. If insulin resistance goes untreated, you can develop type 2 diabetes. Type 2 diabetics, in turn, are much more likely to fall victim to heart disease.

PCOS patients also deal with metabolic syndrome, the features of which include: 

  • High fasting blood sugar levels
  • An abnormal lipid (fat) profile
  • High blood pressure
  • Central obesity — fat around the abdomen

In addition, metabolic syndrome creates chronic inflammation of a kind that has been linked to the atherosclerosis we already looked at. Atherosclerosis is, remember, a plaque build-up within the walls of the arteries, and it greatly increases your risk of heart disease. Research suggests that PCOS patients have about twice the risk of developing atherosclerosis compared to people who don't have PCOS. 

3. Warning: The menopause negatively affects your risk of heart disease too

Statistics show that cardiovascular disease is more likely to strike in women with PCOS who have entered the menopause. This probably has a lot to do with high plasma homocysteine (Hcy) levels, which increase after the menopause and are themselves known to increase the odds that someone will develop cardiovascular disease. Having high insulin levels can contribute to high homocysteine , as well as leading to an increase in inflammatory cytokines. 

What does this mean for postmenopausal women who were previously diagnosed with PCOS? Hormone replacement therapy seems to cut your risk of heart disease somewhat in this situation, but because it does contribute to other adverse health outcomes such as cancer, it is wise to discuss the pros and cons with your doctor before deciding to take HRT. 

4. What do PCOS patients need to know about high blood pressure?

You have high blood pressure if your systolic pressure is usually over 140 mmHg, while your diastolic pressure exceeds 90 — if you're not sure what your blood pressure is like, consider investing in a monitor. One study found that women with PCOS are twice as likely as others to suffer from hypertension, and this is because of the insulin resistance and high androgen levels seen in PCOS patients. If you do have high blood pressure, you may require medication — talk to your doctor if you measure your blood pressure at home and have noticed that it is higher than it should be.

5. How does smoking and drinking contribute to your risk of a heart disease?

Smoking — any amount — and drinking too much alcohol are two risk factors for heart disease that you can control, unlike, say, the fact that you have PCOS. 

Smoking causes the arteries to become more narrow, among many other bad things, and thereby adds to your risk of angina, a heart attack, or a stroke. Because you already have other risk factors for heart disease as a PCOS patient, it's important that you stop smoking if you are currently a smoker. 

Alcohol may be fine in moderation, but it's bad news if you have too much. Excessive booze consumption can send your triglycerides through the roof, lead to hypertension, and cause heart failure. Because alcohol also contains calories (a lot, depending on the drink), it can also contribute to obesity, another thing that increases your risk of cardiovascular disease. To be on the safe side, please stick to no more than 14 units of alcohol a week, and spread them out rather than binge drinking.

6. A healthy weight lowers your risk of heart disease

Obesity is extremely common in women with PCOS, and it is, unfortunately, another thing that adds to your risk of heart disease. Ask your doctor what your BMI is, or calculate it yourself, and be aware that the ideal body mass index is under 25. The best ways to lose weight include:

  • Exercise — both cardio and strength training, about five times a week for at least 30 minutes if you can. 
  • Diet — if you are insulin resistant, you will want to look into a low glycemic index diet rich in vegetables and fruits that don't cause intense blood sugar fluctuations. Cut down on the processed junk foods, rich in sugar and salt.

7. Medications may help you

Has your doctor determined that you are vulnerable to heart disease? They may suggest medications, such as:

  • Statins — medications that reduce cholesterol levels
  • Antihypertensives if you have high blood pressure
  • Aspirin, in low doses, to reduce your risk of blood clots
  • Metformin, a medication used for diabetes, is also prescribed to women with PCOS who are insulin resistant. It can also help normalize your blood pressure, research indicates, improve your lipid profile, and help in the fight against atherosclerosis.
  • Folic acid supplements to improve your homocysteine levels

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