Cardiometabolic Risk in Adolescent Polycystic Ovary Syndrome: Bridging Endocrinology, Gynecology, and Preventive Cardiology

Abstract

Background: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in adolescents‚ affecting around 6-10% of the global population․ While previously considered a reproductive and gynecological disorder‚ PCOS is now viewed as a chronic‚ multisystemic metabolic and cardiovascular disorder that begins in early life and continues throughout adulthood․ Objective: This study intended to summarize opportunities created by combining pediatric endocrinology‚ pediatric gynecology‚ and preventive cardiology to identify and risk stratify for subclinical cardiovascular dysfunction in early adolescence‚ an important developmental and pubertal transition period․ Methods: This is a qualitative review of the contemporary literature‚ including primary research‚ meta-analyzes‚ and clinical practice guidelines on adolescent PCOS‚ adipose tissue dysfunction‚ and advanced cardiovascular imaging․ Discussion: The most important endocrine abnormality in PCOS is marked insulin resistance and associated compensatory hyperinsulinemia․ Thus‚ the metabolic disturbances and adverse adipokine profile in "Lean PCOS" phenotypes indicate that severe cardiometabolic risk exists beyond simply that of common clinical obesity․ Cardiovascular dysfunction associated with the metabolic syndrome occurs in youth‚ with PCOS adolescents already showing increased arterial stiffness‚ subclinical atherosclerosis‚ and early vascular ageing․ Important deposition of massive epicardial adipose tissue (EAT) is also seen․ EAT is a metabolically active visceral fat depot with pro-inflammatory‚ metabolically harmful properties that directly affect coronary and myocardial dysfunction․ Due to preserved ejection fraction in early stage disease‚ advanced imaging‚ including speckle tracking echocardiography‚ is often required to assess mechanical impairment of the heart․ These abnormalities include impaired left ventricular global longitudinal strain‚ subclinical right ventricular dysfunction‚ and complex biventricular mechanical dispersion․ Conclusion: Effective prevention of premature cardiovascular disease in adolescent PCOS requires the transition from symptom-based‚ fragmented care to multidisciplinary cardio-metabolic-gynecologic clinics‚ and standardized advanced imaging protocols along with rigorous cardiovascular and metabolic screening․ With these tools‚ it is possible to change the lifelong cardiovascular trajectory of this high-risk population․

Keywords: Polycystic ovary syndrome, adolescents, insulin resistance, adiposity.