University of Oulu

Ollila M, Kiviniemi A, Stener-Victorin E, et al. Effect of polycystic ovary syndrome on cardiac autonomic function at a late fertile age: a prospective Northern Finland Birth Cohort 1966 study, BMJ Open 2019; 9,:e033780. doi: 10.1136/bmjopen-2019-033780

Effect of polycystic ovary syndrome on cardiac autonomic function at a late fertile age : a prospective Northern Finland Birth Cohort 1966 study

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Author: Ollila, Meri-Maija1; Kiviniemi, Antti2; Stener-Victorin, Elisabet3;
Organizations: 1Department of Obstetrics and Gynaecology, University of Oulu and Oulu University Hospital, Medical Research Centre, PEDEGO Research Unit, Oulu, Finland
2Research Unit of Internal Medicine, Medical Research Centre Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
3Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
4NordLab Oulu, Department of Clinical Chemistry, University of Oulu and Oulu University Hospital, Medical Research Centre Oulu, Oulu, Finland
5Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
6Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.6 MB)
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Language: English
Published: BMJ, 2019
Publish Date: 2020-04-28


Objectives: Previous studies of women in their 20s and 30s have reported impaired autonomic function in women with polycystic ovary syndrome (PCOS). We aimed to study, for the first time, whether PCOS is associated with impaired cardiac autonomic function independent of metabolic and hormonal status in their late reproductive years.

Design: A prospective Northern Finland Birth Cohort 1966 (NFBC1966) study including 5889 women born in 1966 and followed through the age of 46. At that age, n=3706/5123 women (72%) answered the postal questionnaires and n=3280/5123 women (64%) participated in the clinical examination.

Setting: General community.

Participants: The sample included women presenting both irregular menses (oligomenorrhoea or amenorrhoea) and hirsutism at age 31 (n=125) or with formally diagnosed PCOS by age 46 (n=181) and women without PCOS symptoms or diagnosis (n=1577).

Primary and secondary outcome measures: Heart rate variability parameters: the root mean square of successive R-R differences (rMSSD), spectral power densities (LF: low frequency and HF: high frequency) and baroreflex sensitivity (BRS).

Results: We found that parasympathetic activity (assessed by rMSSD: 19.5 (12.4; 31.9) vs 24.3 (16.1; 34.8) ms, p=0.004 and HF: 172 (75; 399) vs 261 (112; 565) ms2, p=0.002) and BRS (6.13±3.12 vs 6.99±3.52 ms/mm Hg, p=0.036) were lower in women with PCOS compared with the controls. However, in the multivariate regression analysis, PCOS, body mass index and the free androgen index did not significantly associate with rMSSD, whereas blood pressure, insulin resistance and triglycerides did.

Conclusions: We report here for the first time that late reproductive-aged women with PCOS display impaired cardiac autonomic function manifested as decreased vagal activity. Metabolic status, rather than hyperandrogenaemia and PCOS per se, was the strongest contributing factor. Given the link between cardiac morbidity and impaired autonomic function, the findings underline the importance of screening and treating metabolic abnormalities early on in women with PCOS.

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Series: BMJ open
ISSN: 2044-6055
ISSN-E: 2044-6055
ISSN-L: 2044-6055
Volume: 9
Issue: 12
Article number: 033780
DOI: 10.1136/bmjopen-2019-033780
Type of Publication: A1 Journal article – refereed
Field of Science: 3123 Gynaecology and paediatrics
Funding: This work was supported by grants from the Finnish Medical Foundation, the North Ostrobothnia Regional Fund, the Academy of Finland (project grants 315921, 321763, 104781, 120315, 129269, 1114194, 24300796), the Center of Excellence in Complex Disease Genetics, SALVE, the Sigrid Jusélius Foundation, Biocenter Oulu, University Hospital Oulu and the University of Oulu (75617), Medical Research Center Oulu, the National Institute for Health Research (UK), NHLBI grant 5R01HL087679-02 through the STAMPEED program (1RL1MH083268-01), NIH/NIMH (5R01MH63706:02), the ENGAGE project and grant agreement HEALTH-F4-2007-201413, EU FP7 EurHEALTHAgeing (277849), the Medical Research Council UK (G0500539, G0600705, G1002319, G0802782, PrevMetSyn/SALVE), the MRC, the Centenary Early Career Award, the Paulo Foundation, the Finnish Foundation for Cardiovascular Research and the Jane and Aatos Erkko Foundation
EU Grant Number: (277849) EURHEALTHAGEING - European ResearcH on DevElopmentAL, BirtH and Genetic Determinants of Ageing
Academy of Finland Grant Number: 315921
Detailed Information: 315921 (Academy of Finland Funding decision)
321763 (Academy of Finland Funding decision)
129269 (Academy of Finland Funding decision)
114194 (Academy of Finland Funding decision)
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