PCOS May Raise Cardiovascular Risk Even in Women Without Obesity

A large new study published in the European Journal of Endocrinology involving more than 700,000 women from Denmark, Finland and Sweden is adding to growing evidence that polycystic ovary syndrome (PCOS) may significantly increase the risk of cardiovascular disease (CVD), even in women who are not overweight or living with Type 2 diabetes.

PCOS is one of the most common hormonal disorders affecting women of reproductive age. It is often associated with irregular periods, elevated androgen levels, ovarian cysts, fertility challenges, insulin resistance and metabolic issues. Previous research has already linked PCOS to risk factors for heart disease, such as obesity, high blood pressure and diabetes. However, researchers say long-term population-based studies examining actual cardiovascular outcomes have been limited.

“To our knowledge, our study is the first to combine results from several nationwide study cohorts and evaluate the prospective risk of cardiovascular disease in women with polycystic ovary syndrome,” noted lead investigator Dorte Glintborg, Ph.D., a professor from the University of Southern Denmark and Odense University Hospital.

To better understand the relationship, investigators analyzed national health registry data from more than 127,000 women with PCOS and nearly 588,000 age-matched women without PCOS across the three Nordic countries. Participants were followed for approximately eight to 10 years, beginning at a median age of 28 to 29 years.

Investigators looked at rates of cardiovascular disease, including major adverse cardiac events, pulmonary embolism (blood clots in the lungs) and deep vein thrombosis (blood clots in the legs). Across all three countries, women with PCOS consistently showed a higher risk of developing cardiovascular disease compared with women without the condition.

When investigators combined the data from all three countries, they found women with PCOS had a 32% higher adjusted risk of cardiovascular disease overall. Importantly, the increased risk remained even after researchers adjusted for body mass index (BMI) and education level, suggesting that PCOS itself may contribute to cardiovascular risk beyond the effects of obesity alone.

One of the study’s most notable findings was that cardiovascular risk was also elevated in women with PCOS who had a BMI below 25 and who did not have Type 2 diabetes. In this group, the risk of cardiovascular disease was still 40% higher compared with women without PCOS.

“The fact that women with PCOS of normal weight also have an increased cardiovascular disease risk suggests that the biology of the condition itself — such as the high levels of testosterone — may affect the cardiovascular system, independently of weight and Type 2 diabetes,” said Glintborg.

For patients, the findings reinforce that PCOS is not only a reproductive or fertility-related condition but may also have long-term implications for heart and blood vessel health. Researchers say the study highlights the importance of early cardiovascular risk assessment, regular monitoring of blood pressure and cholesterol, physical activity, healthy nutrition and discussions with health care providers about long-term heart health.

While the study does not prove that PCOS directly causes cardiovascular disease, it strongly suggests that women with PCOS may benefit from earlier prevention strategies and ongoing cardiovascular care — even if they are young, have a normal weight or do not have diabetes.

“We are most likely moving away from seeing PCOS as one single, uniform diagnosis but rather PCOS could be divided into different long-term risk patterns, such as diabetes and cardiovascular disease,” said Glintborg. “In the long term, we hope to be able to give each woman a more precise picture of her risk and a plan that extends beyond the next fertility treatment.”