Cardiometabolic trajectories across midlife in parous women with polycystic ovary syndrome

Compare cardiometabolic trajectories of 557 parous women with diagnosed, probable, and no polycystic ovary syndrome (PCOS) throughout 15-year follow-up (2002-2021). We defined PCOS status as: (1) clinically diagnosed; (2) probable: without diagnosis but ≥2 of the following: cycle length <21 or ≥35 days, free testosterone >75th percentile, or anti-Müllerian hormone >75th percentile; (3) no PCOS. Outcomes included longitudinal adiposity, blood pressure, lipids, glycemia, and adipokines. We used mixed-effects models to examine associations of PCOS status with the outcomes, adjusting for covariates. Women were 37 ± 5 years at baseline; 9.7% had diagnosed and 9.2% probable PCOS. Throughout follow-up, women with diagnosed versus no PCOS had higher adiposity, systolic blood pressure, triglycerides, hemoglobin A1c, fasting glucose, insulin, and leptin; and lower high-density lipoprotein and adiponectin. However, the diagnosed and probable PCOS groups had similar hemoglobin A1c (0.16 [95% CI, -0.20 to 0.52]), leptin (-4.20 [95% CI, -16.61 to 8.22] ng/mL), and adiponectin (0.99 [95% CI, -2.15 to 4.13] μg/mL). Both groups had less favorable profiles than women without PCOS, even after body mass index adjustment. Although women with diagnosed PCOS have the least favorable cardiometabolic profile throughout midlife, those with probable PCOS exhibited comparable glycemia and an altered adipokine pattern suggestive of adipocyte dysfunction independent of adiposity.