University Times

While it is not uncommon for men to suffer heart attacks in their 40s and 50s, women generally don't run a significant risk of heart disease until years after menopause, when their bodies stop producing substantial amounts of the hormone estrogen.

But a new Pitt study shows that up to 10 percent of American women suffer from a syndrome that negates this natural protection against heart disease.

The condition, called polycystic ovary syndrome (PCOS), puts premenopausal women as much at risk of heart and blood vessel disease as men their age, according to the study's findings.

Women with PCOS typically ovulate infrequently and have irregular menstrual periods and higher-than-normal levels of the male hormone testosterone, Pitt researchers say, adding that many, but not all, women with PCOS are infertile and have excess body and facial hair, adult acne and weight gain.

The hormonal imbalances of women with PCOS often prevent their ovaries from releasing eggs into the fallopian tubes; the distinctive pearly-white cysts dotting the surface of their ovaries are eggs that never were released.

"Women who have a history of irregular [menstrual] bleeding and who have trouble with unwanted facial hair or other manifestations of excess androgens such as oily skin, acne and so forth — those two things in combination should alert them that they might have PCOS," said David Guzik, professor of obstetrics, gynecology and reproductive sciences at Pitt's medical school and one of the researchers who contributed to the PCOS study.

Guzik and epidemiology professor Evelyn Talbott, first author of the report, said their study compared 206 Pittsburgh area women with the syndrome to a control group of women matched to each PCOS subject by age, race and neighborhood. The women with PCOS had higher blood pressure and body mass, as well as increased "bad" LDL cholesterol, triglycerides (fat in the blood), total cholesterol and insulin levels — all known risk factors for heart disease.

The youngest PCOS women, who were in their late 20s and early 30s, had especially high levels of those risk factors compared with women without the syndrome, researchers said.

The findings appear this month in Arteriosclerosis, Thrombosis and Vascular Biology, an American Heart Association journal.

At a July 13 press conference, Talbott and Guzik said PCOS often is not diagnosed. Although the syndrome usually begins in puberty, women with PCOS may be unaware of it until they find they are unable to have children, the researchers said.

Even then, physicians may treat individual symptoms rather than PCOS itself. For example, doctors may prescribe oral contraceptives to regulate menstruation or drugs to induce ovulation and not recognize the combination of conditions that constitute the syndrome, Guzik said.

When a woman asks her physician for help with infertility or hairiness, the doctor should consider testing for PCOS and recommending a "heart-healthy" lifestyle to women with abnormal hormone levels, Talbott and Guzik said. Noting that the average weight of the PCOS women in their study was 177 pounds, the researchers said women with the syndrome should control their weight and blood pressure, abstain from smoking, adopt a low-fat diet and exercise regularly. There is no single test or "cure" for PCOS.

Most of the PCOS women in the Pitt study had "significantly elevated" levels of testosterone, the male sex hormone, which normally is present in small amounts in all women. Women with the syndrome also tended to have higher-than-usual insulin levels.

Talbott and Guzik said the syndrome's origins aren't fully understood, but that a genetic flaw — a counterpart of the one that causes premature baldness in men — may be the cause in some cases.

The Pitt researchers said their study represents the largest number of PCOS cases and matched controls to date. Earlier studies of the syndrome, done mainly in England, involved small numbers of subjects, they said.

— Bruce Steele