Study: Black Women with PCOS Have Greater Cardiometabolic Risk vs White Women

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Research presented at ENDO 2021 suggests Black women with polycystic ovary syndrome (PCOS) are at a greater risk for heart disease, diabetes, and stroke compared to White women with PCOS.

PCOS is common, affecting an estimated 10% of women of childbearing age, but according to results of the systematic review and meta-analysis, the cardiometabolic risk profiles among Black women with PCOS were significantly poorer than among their White counterparts, including greater levels of insulin resistance and higher blood pressure.

“Our findings support the need to increase public awareness about the disproportionate burden of cardiometabolic risk in young Black women with PCOS,” said Maryam Kazemi, PhD, a Postdoctoral Associate in Professor Marla Lujan's laboratory in the Division of Nutritional Sciences at Cornell University, in an Endocrine Society statement. “These findings have implications for improving the sensitivity of clinical assessments in Black women to avoid underestimating cardiovascular risk in women with PCOS.”

Discovering the paucity of information related to cardiometabolic and reproductive differences based on race/ethnicity, Kazemi and colleagues searched MEDLINE, Web of Science, and Scopus databases Between January 1990-September 2020 for existing observational studies documenting the risk profiles for Black and White women with PCOS.

Of the more than 3300 articles identified, 11 met inclusion criteria for the qualitative analysis and 10 for the meta-analysis. Studies on children (<17 yrs), pregnant, or menopausal-aged (> 50 yrs) women were excluded. Total participants were 2851 (626 Black, 2195 White). Cardiometabolic risk features examined included glucoregulatory data, lipid profile, anthropometric measures, and hypertension status.

The primary outcome of the study was fasting glucose. Other outcomes of interest included cardiovascular events, such as stroke, coronary heart disease, and heart failure, as well as all-cause and cardiovascular mortality.

From the 11 studies identified for inclusion, investigators obtained data related to 2821 women with PCOS, including 626 Black women and 2195 White women. Investigators noted none of these studies reported on cardiovascular events/mortality rate among patients examined.

The analysis found that Black women with PCOS had comparable fasting glucose (-0.61 [-1.69, 2.92] mg/dL; I2 = 62.5%) compared to White women but that fasting insulin levels were increased (6.76 [4.97, 8.56] µIU/mL; I2 = 59.0%) on comparison.

HOMA-IR (HOMA-IR; 1.47 [0.86-2.08]; I2=83.2%), and systolic blood pressure (3.32 [0.34-6.30] mmHg; I2=52.0%) also were increased in Black participants while triglyceride levels were decreased e (-32.56 [-54.69, -10.42] mg/dL; I2 = 68.0%); (P ≤.03 for all).

The 2 groups were comparable in levels of total cholesterol, LDL-C, HDL-C, and diastolic blood pressure (P >.06 for all).

The relative dearth of studies that evaluated hard endpoints, ie, CV events or mortality, the authors said, limit the conclusions that can be made about potential disparities. 

"We found a disproportionate risk for health complications in Black women with PCOS in the United States, highlighting the need to fully identify and address health disparities in women with PCOS," added Kazemi in the statement.

The authors conclude: "Our observations support consideration of these disparities for diagnostic, monitoring, management, and public health practices, and for future guideline recommendations."

Reference: Kazemi M, Kim JY, Parry PA, Azziz R, Lujan ME. Black women have worse cardio-metabolic risk profiles compared to white women with polycystic ovary syndrome in the United States: a systematic review and meta-analysis. Presented virtually at ENDO 2021.

For more coverage of ENDO 2021, please click here.