PCOS Is More Than a Reproductive Disorder: A New Perspective on Cardiovascular Risk in Women
Overview of Polycystic Ovary Syndrome
Polycystic ovary syndrome, or PCOS, is the most common endocrine disorder in women, affecting approximately 12% of women globally. Since its first description in 1935, PCOS has no longer been viewed solely as a reproductive disorder, but increasingly as a complex endocrine–metabolic syndrome that may persist throughout life.
In adults, PCOS is commonly diagnosed based on the Rotterdam criteria, requiring at least two of the following three features: chronic anovulation, clinical or biochemical hyperandrogenism, and polycystic ovarian morphology on ultrasound or elevated anti-Müllerian hormone levels.
The pathophysiology of PCOS involves a complex interaction between genetic factors, lifestyle, and obesity, which may drive core endocrine disturbances such as insulin resistance and hyperandrogenism. Beyond its effects on fertility and menstrual regularity, PCOS is also associated with multiple cardiometabolic disorders, including dyslipidemia, hypertension, gestational diabetes, and metabolic syndrome.
The Link Between PCOS and Cardiovascular Risk
For decades, the association between PCOS and cardiovascular disease was mainly explained by the higher prevalence of obesity and type 2 diabetes in this population. However, recent evidence suggests that PCOS itself may be an independent and clinically relevant risk factor for cardiovascular disease.
This risk is not simply a consequence of excess body weight. Women with PCOS may show subclinical cardiovascular markers earlier than the general population, including increased carotid intima-media thickness, higher coronary artery calcium scores, and endothelial dysfunction. Potential mechanisms include chronic low-grade inflammation, oxidative stress, and the adverse effects of elevated androgen levels on the vascular system.
Despite these risks, PCOS has often been underrecognized in cardiology, partly because it has traditionally been viewed as a “silent” women’s health condition rather than a disorder with long-term metabolic and cardiovascular implications.
Scientific Evidence: Data from Large-Scale Studies
One of the key sources of evidence linking PCOS with cardiovascular disease comes from the 2023 International Evidence-Based Guideline for PCOS. This update included a systematic review and meta-analysis of 20 studies involving more than 1.06 million women, including 369,317 women with PCOS and 692,963 women without PCOS.
Key findings from the meta-analysis:
- Composite cardiovascular disease: Women with PCOS had a significantly higher risk, with an OR of 1.68.
- Myocardial infarction: The risk was more than doubled compared with controls, with an OR of 2.50.
- Stroke: Women with PCOS had a notably increased risk, with an OR of 1.71.
- Ischemic heart disease: PCOS was also associated with a higher risk, with an OR of 1.48.
A Key Finding: Risk Persists Even in Women with Normal Weight
A collaborative study across Denmark, Finland, and Sweden involving 127,517 women with PCOS further strengthened this association. The study found that the overall risk of developing heart disease increased by 32% in women with PCOS.
Importantly, women with PCOS who had normal weight, defined as BMI <25 kg/m², still had a 40% higher risk of developing heart disease compared with normal-weight women without PCOS. This finding suggests that the biological nature of PCOS, particularly elevated testosterone levels, may negatively affect the cardiovascular system independently of body weight or diabetes. Moreover, high testosterone levels may cause blood vessels to constrict and become less flexible, potentially increasing cardiac strain over time.
Summary of Key Points
Recent large-scale evidence provides several important messages for clinical practice and public health:
- PCOS is an important cardiovascular risk factor: It is associated with higher risks of myocardial infarction, stroke, and composite cardiovascular disease.
- Risk is not limited to BMI: Increased cardiovascular risk may persist even in women with normal weight and without type 2 diabetes.
- Broader cardiovascular risk assessment is needed: The 2023 international guideline recommends cardiovascular risk assessment for all women with PCOS, regardless of age or BMI. Monitoring should include blood pressure, lipid profile, and glucose tolerance.
- Care should be personalized: PCOS should be approached as a condition requiring comprehensive risk assessment, extending beyond infertility or menstrual irregularity to include long-term cardiovascular health.
Conclusion
PCOS is not only a reproductive disorder but is also significantly associated with cardiovascular risk in women. Recognizing PCOS as a contributor to cardiovascular morbidity may create an opportunity for earlier intervention, appropriate monitoring, and preventive strategies to reduce the long-term burden of cardiovascular disease.
Source
- https://doi.org/10.5812/ijem.4020
- NewsMedical LifeScience – access May 2026
- https://sciencenews.dk/en/pcos-linked-to-higher-risk-of-heart-disease-even-among-women-of-normal-weight
- https://doi.org/10.1161/JAHA.123.033572
Bài viết liên quan
