Black Women with PCOS at Greater Cardiometabolic Risk than White Counterparts

Maryam Kazemi, PhD

Underlining the importance of identifying and proactively addressing racial differences in care, an ENDO 2021 study 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.

While PCOS is common, with some estimates suggesting it impacts 1-in-10 women, the Cornell University-led systematic review and meta-analysis concluded Black women with PCOS had a poorer cardiometabolic risk profile than their White counterparts, including greater levels of insulin resistance and 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 a statement. “These findings have implications for improving the sensitivity of clinical assessments in Black women to avoid underestimating cardiovascular risk in women with PCOS.”

Despite its prevalence among women, Kazemi and team noted there was little available information related to cardiometabolic and reproductive differences based on race/ethnicity. To fill this apparent knowledge gap, the current study was designed the aim of evaluating differences in cardiometabolic profiles of Black and White women with PCOS from previously published observational studies within the MEDLINE, Web of Science, and Scopus databases.

Using a search period of January 1990-September 2020, investigators identified a total of 11 studies including 2851 participants for inclusion in the current analysis. Initially, investigators identified more than 3300 articles, but after application of inclusion criteria and exclusion of duplicates, investigators identified 11 studies for inclusion in their qualitative analysis and 10 for inclusion in their meta-analysis.

Studies included in the analysis examined women between 17-50 years of age and documented cardiometabolic risk profiles of women with PCOS, including glucoregulation, lipid profiles, anthropometric data, and hypertensive status.

The primary outcome of the study was fasting glucose. Other outcomes of interest for the study 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.

Results of the investigators’ analyses indicated Black women had increased fasting insulin (6.76 [4.97-8.56] µIU/mL; I2=59.0%), 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%). However, investigators noted these same models indicated Black women had compared fasting glucose and decreased triglycerides compared to White women (P for all <.03).

Additionally, the study arms were comparable in total cholesterol, LDL-C, HDL-C, and diastolic blood pressure levels (P for all >.06). Investigators pointed out paucity in the number of studies evaluating cardiovascular events or mortality limit conclusions that can be drawn from current data related to 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," Kazemi added.

This study, “Black Women Have a Worse Cardio-Metabolic Risk Profile Compared to White Women with Polycystic Ovary Syndrome in the United States: A Systematic Review and Meta-Analysis,” was presented virtually as part of ENDO 2021.