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Dorte Glintborg, Katrine Hass Rubin, Mads Nybo, Bo Abrahamsen, and Marianne Andersen

Objective

The prevalence of type 2 diabetes is increased in polycystic ovary syndrome (PCOS), but the prevalence of other diseases is not clarified. We aimed to investigate morbidity and medicine prescriptions in PCOS.

Design

A National Register-based study.

Methods

Patients with PCOS (PCOS Denmark and an embedded cohort; PCOS Odense University Hospital (OUH)) and one control population. Premenopausal women with PCOS underwent clinical and biochemical examination (PCOS OUH, n=1217). PCOS Denmark (n=19 199) included women with PCOS in the Danish National Patient Register. Three age-matched controls were included per patient (n=57 483).

Main outcome measures

Diagnosis codes and filled prescriptions.

Results

The mean (range) age of the PCOS Denmark group and controls was 30.6 (12–60) years. Patients in PCOS Denmark had higher Charlson index, higher prevalence of diabetes, dyslipidemia, and hypertension than controls. PCOS was associated with a two times increased risk of stroke and thrombosis, whereas the risk of other cardiovascular diseases was not increased. Thyroid disease, asthma, migraine, and depression were more prevalent in PCOS Denmark vs controls, whereas fractures were rarer. Infertility was increased in patients compared with controls, but the mean number of births was higher in PCOS. Medicine prescriptions within all diagnosis areas were significantly higher in PCOS patients than in controls.

In PCOS OUH, polycystic ovaries (PCO) and irregular menses were associated with a more adverse metabolic risk profile, but individual Rotterdam criteria were not associated with cardiometabolic diagnoses.

Conclusion

Cardiometabolic and psychiatric morbidity were significantly increased in a Danish population with PCOS. Medical diseases are frequent also in young patients with PCOS.

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Dorte Glintborg, Katrine Hass Rubin, Tanja Gram Petersen, Øjvind Lidegaard, Guy T’Sjoen, Malene Hilden, and Marianne Skovsager Andersen

Background

Cardiovascular risk could be increased in transgender persons, but the mechanism is undetermined.

Aim

The aim of this study was to assess the risk of cardiovascular outcomes in Danish transgender persons compared to controls.

Methods

The study design was a historical register-based cohort study in Danish transgenders and age-matched controls. The main outcome measure was cardiovascular diagnosis (any CVD) including medicine prescriptions for CVD during 2000–2018. The transgender cohort (n = 2671) included persons with International Classification of Diseases-10 diagnosis code of ‘gender identity disorder’ (n = 1583) and persons with legal sex change (n = 1088), 1270 were assigned female at birth (AFAB) and 1401 were assigned male at birth (AMAB). Controls (n = 26 710) were matched by age (n = 5 controls of same and n  = 5 controls of other birth sex) of the respective transgender.

Results

The median (interquartile range) age at study inclusion was 22 (18; 29) years for AFAB and 26 (21; 39) years for AMAB. The mean (s.d.) follow-up time was 4.5 (4.2) years for AFAB and 5.7 (4.8) years for AMAB. The hazard ratio (HR) for any CVD was significantly higher in transgenders vs controls of same and other birth sex, with highest adjusted HR in transgenders AFAB vs control men: 2.20 (95% CI: 1.64;2.95), P < 0.001. Gender-affirming hormone treatment (GAHT) explained part of elevated risk of CVD in transgenders AFAB, whereas GAHT did not contribute to the elevated risk of CVD in transgenders AMAB.

Conclusions

The risk of cardiovascular diagnosis was increased in transgenders. The mechanism should be further investigated.