Cardiovascular profile of pharmacological agents used for the management of polycystic ovary syndrome

Abstract

Women with polycystic ovary syndrome (PCOS) have an adverse metabolic profile with an increased risk of prediabetes and type 2 diabetes (T2DM); however, it is unclear if PCOS is associated with increased cardiovascular events in later years independent of the presence of T2DM. Many therapies have been used to treat the differing facets of PCOS, including those for menstrual irregularity, hirsutism, acne and anovulatory infertility. The aim of this review was to evaluate the cardiovascular profiles associated with the medications used in the management of PCOS and evaluate whether they have cardiovascular benefit, detriment or are neutral. The medications reviewed include oral contraceptive pills, antiandrogens, clomiphene and drugs specifically used in diabetes therapy; metformin, glitazones, dipeptidyl peptidase IV inhibitors and glucagon-like peptide-1 receptor agonists. This review concludes that therapies that are used to treat these patients appear not to add to the cardiovascular risk and that there is no evidence that any interventional medical therapy may prevent the onset of diabetes in patients with PCOS, though in the case of metformin, this agent may be beneficial in preventing development of gestational diabetes.

Keywords: PCOS; Pharmacotherapy; androgen; cardiovascular risk; clomiphene; oral contraceptives.

Figure 1.

Therapeutic targets in polycystic ovary syndrome and pharmacological treatment (not all may be licensed in different countries). Targets in italics are those not specifically addressed clinically. GLP-RA: Glucagon like peptide receptor agonist; CPAP: Continous positive airway pressure.