Cardiometabolic Risk in Women with Premature Ovarian Insufficiency: A Systematic Review and Meta-analysis
Peng Wu, Hongfan Ding, Jiajia Wang, Huimei Wu, Feiwen Li, Weilong Peng, Zhaoyang Yu
Background: Premature ovarian insufficiency (POI) is defined as a reproductive endocrine syndrome,
which is considered to be associated with cardiometabolic risk due to early deficiency of estrogens.
Nevertheless, current studies fail to reach a consensus, and systematic reviews and meta-analysis are
required to quantify the relevance of these longitudinal studies.
Objective: To systematically evaluate optimal evidence regarding the association between POI and
cardiometabolic risk factors.
Methods: By searching PubMed, EMBASE, Web of Science to determined the eligible studies comparing
the cardiometabolic risk factor among women with POI and healthy control, started on August 15,
2021 and no search date restrictions. Data was conducted by random effects model and reported as
standardized mean difference (SMD) with 95% confidence intervals (CI).
Results: The meta-analysis showed that women with POI had statistically significant increased level of
total cholesterol (SMD=0.48, 95%CI (0.31,0.65)), triglycerides (SMD=0.18, 95%CI (0.07,0.30)), lowdensity lipoprotein cholesterol (SMD=0.41, 95%CI (0.21,0.61)), blood glucose (SMD=0.40, 95%CI
(0.17,0.63)), insulin (SMD=0.34, 95%CI (0.02,0.66)) compared with control women. While there
was no statisticly difference in high-density lipoprotein cholesterol (SMD=0.08, 95%CI (-0.14,0.03)),
systolic blood pressure (SMD=0.03, 95%CI (-0.18,0.23)), diastolic blood pressure (SMD=0.01, 95%CI
(- 0.26,0.28)) and incidence of metabolic syndrome (OR=2.51, 95%CI (0.6,10.47)) between women with
and without POI. Heterogeneity was significantly reduced after subgroup analysis based on geographic
distribution. Sensitivity analysis suggested all outcomes were relatively stable. Begg's funnel plot
analysis indicated no publication bias for all factors except of LDL-C (P=0.036).
Conclusions: There was higher presence of cardiometabolic risk factors in women with POI. These
adverse changes of cardiometabolic indicators can prompt clinicians to focus on cardiometabolic risk
in POI women earlier rather than until the onset of long-term complications, so as to facilitate the
initiation of intervention and HRT treatment timely.
