Study: Women With PCOS at Increased Risk of Acute Myocardial Infarction and Ischemic Stroke

Women with polycystic ovarian syndrome (PCOS) have an increased risk of acute myocardial infarction and ischemic stroke compared with participants without PCOS, according to abstract authors who presented their research at the 2025 European Society of Cardiology Congress.

These findings, the authors emphasized, highlight the need to assess cardiovascular risk early and implement preventative strategies for patients with PCOS.¹

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PCOS is a condition that affects an individual’s hormones throughout their reproductive years. According to the abstract authors, the condition affects approximately 5% to 20% of reproductive-aged women. Some patients may not menstruate regularly, and others may find that they menstruate for a longer duration than someone without PCOS. Patients with PCOS may have an abundance of the hormone androgen in their bodies.²

Although the exact cause of PCOS is not known, experts speculate that insulin resistance, low-grade inflammation, heredity, and excess androgen play a role in its onset. The condition itself is characterized by many small sacs of fluid—cysts—that develop along the outer edge of the ovary.²

Other complications include infertility; type 2 diabetes or prediabetes; endometrial cancer; depression, anxiety, and eating disorders; and metabolic syndrome, or a cluster of conditions that include hypertension, high blood sugar, and unhealthy cholesterol or triglyceride levels.²

For this study, the investigators identified women who were diagnosed with PCOS from 1995 to 2024 via Danish nationwide registries. These women were then matched 1:4 with female controls from the background population by age and year of index. The study’s primary end point was a composite of acute myocardial infarction and ischemic stroke, with the individual components serving as secondary end points.¹

A total of 25,513 women with PCOS and 102,052 matched controls (median age: 29.9 years) were enrolled in this study. The investigators observed that women with PCOS had a higher prevalence of cardiovascular risk factors compared with their healthy counterparts. The 25-year cumulative incidence of the composite outcome was higher in women with PCOS (3.4% [95% CI 2.8–4.2%]) compared with controls (2.0% [95% CI 1.8–2.3%]).¹

Further, in Cox regression analyses, PCOS was associated with an increased risk of the composite outcome (unadjusted HR: 1.82 [95% CI 1.56–2.11]; adjusted HR: 1.53 [95% CI 1.30–1.81]), acute myocardial infarction (unadjusted HR: 1.86 [95% CI 1.45–2.39]; adjusted HR: 1.58 [95% CI 1.21–2.07]), and ischemic stroke (unadjusted HR: 1.83 [95% CI 1.52–2.22]; adjusted HR: 1.56 [95% CI 1.27–1.91]). Significantly, these associations did not appear to vary by use of oral contraception, metformin, or glucagon-like peptide-1 analogs.¹

These findings are significant because they confirm prior evidence that PCOS is associated with cardiovascular risks. One such piece of evidence stems from a 2023 systematic review and meta-analysis that evaluated 20 studies enrolling over 1.06 million women with or without PCOS. That paper found PCOS was associated with a higher risk of composite cardiovascular disease (OR: 1.68 [95% CI 1.26–2.23]; I² = 71.0%), composite ischemic heart disease (OR: 1.48 [95% CI 1.07–2.05]; I² = 81.0%), myocardial infarction (OR: 2.50 [95% CI 1.43–4.38]; I² = 83.3%), and stroke (OR: 1.71 [95% CI 1.20–2.44]; I² = 81.4%). However, in this example, the relationship with cardiovascular-related mortality was less clear (OR: 1.19 [95% CI 0.53–2.69]; I² = 0%).³

Regardless, the abstract authors emphasized the need for early cardiovascular risk assessment and the implementation of preventative strategies in women with PCOS. Such measures can help mitigate the burden of cardiovascular-related complications in a vulnerable patient population.^1,3

REFERENCES

1. Havers-Borgersen E, Ekelund C, Svendsen P, et al. impact of advanced chronic kidney disease stages on heart failure mortality: a nationwide analysis using CDC WONDER. Presented at: European Society of Cardiology Congress; Madrid, Spain. August 29–September 1. https://esc365.escardio.org/ESC-Congress/abstract?text=reproductive&docType=All&days&page=1&vue=cards#:~:text=%C3%97-,Women%20with%20polycystic%20ovarian%20syndrome%20are%20at%20increased%20associated%20risk%20of%20acute%20myocardial%20infarction%20and%20ischemic%20stroke,-Authors

2. Mayo Clinic. Polycystic ovary syndrome (PCOS). Accessed September 10, 2025. https://www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439

3. Tay CT, Mousa A, Vyas A, Pattuwage L, Tehrani FR, Teede H. 2023 International Evidence‐Based Polycystic Ovary Syndrome Guideline Update: Insights From a Systematic Review and Meta‐Analysis on Elevated Clinical Cardiovascular Disease in Polycystic Ovary Syndrome. JAHA. 2023;13(16). doi:10.1161/JAHA.123.033572