Disparities in cardio-metabolic risk between Black and White women with polycystic ovary syndrome: a systematic review and meta-analysis

ABSTRACT Objective We conducted a systematic review and meta-analysis to summarize and quantitatively pool evidence on cardio-metabolic health disparities between Black and White women with polycystic ovary syndrome (PCOS) in the United States in response to the call for further delineation of these disparities in the International Evidence-based Guideline for the Assessment and Management of PCOS. Data sources Databases of MEDLINE, Web of Science, and Scopus were searched initially through March 05, 2020, and confirmed on September 11, 2020. Study eligibility criteria Observational studies documenting cardio-metabolic risk profile (glucoregulatory, lipid profile, anthropometric, and blood pressure [BP] status) in Black and White women with PCOS were included. Studies on children ( 50yrs.) women were excluded. The primary outcome was fasting glucose. Further, data on major cardiovascular events (stroke, coronary heart disease, heart failure) and mortality rate (cardiovascular death, total mortality) were evaluated. Study appraisal and synthesis methods Data were pooled by random-effects models and expressed as mean differences and 95% confidence intervals. Studies were weighted based on the inverse of the variance. Heterogeneity was evaluated by Cochran Q and I2 statistics. Study methodologic quality was assessed by the Newcastle-Ottawa scale (NOS). Results Eleven studies (n=2851; [652 Black and 2199 White]) evaluated cardio-metabolic risk profile and all had high quality (NOS score≥8). No studies reported on cardiovascular events/mortality rate. Black women had comparable fasting glucose (-0.61 [-1.69 to 2.92] mg/dL; I2=62.5%), yet exhibited increased fasting insulin (6.76 [4.97 to 8.56] μIU/mL; I2=59.0%); homeostatic model assessment of insulin resistance (HOMA-IR;1.47 [0.86 to 2.08]; I2=83.2%); systolic BP (SBP,3.32 [0.34 to 6.30] mmHg; I2=52.0%) and decreased triglyceride (-32.56 [-54.69 to -10.42] mg/dL; I2=68.0%) compared to White women (All: P≤0.03). Groups exhibited comparable total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and diastolic BP (All: P≥0.06). Conclusions Black women with PCOS have a greater tendency for an adverse cardio-metabolic risk profile (increased insulin, HOMA-IR, and SBP) despite lower triglycerides than White women. Our observations support consideration of these disparities for diagnostic, monitoring, and management practices in Black women and for future Guideline recommendations. Given the heterogeneity among studies, future research should address the relative contributions of biological, environmental, socioeconomic, and healthcare factors to the observed disparities. Further, longitudinal research is required to address patient-pressing complications, including cardiovascular events and mortality rate in Black women with PCOS as a high-risk yet under-studied population.