Risk of cardiovascular and cerebrovascular events in polycystic ovarian syndrome women: An updated meta-analysis of cohort studies

Polycystic ovary syndrome (PCOS), affecting 5-10% of reproductive-aged women, is linked to metabolic disturbances such as insulin resistance, obesity, and lipid imbalance, which may elevate cardiovascular disease (CVD) risk. The relationship between PCOS and clinical cardiovascular events remains unclear. This meta-analysis evaluates the association between PCOS and cardiovascular and cerebrovascular events, including myocardial infarction (MI), stroke, ischemic heart disease (IHD), and overall CVD. We conducted a systematic review and meta-analysis of observational cohort studies published up to August 2024. Studies investigating the association between PCOS and cardiovascular or cerebrovascular events were included. Hazard ratios (HR) were used to assess mortality risk, while odds ratios (OR) evaluated CVD incidence. Statistical analyses were performed using STATA software, with publication bias assessed via funnel plots. Nineteen cohort studies, involving 1,222,912 participants, were analyzed. Women with PCOS had a significantly higher risk of stroke [OR: 1.89, 95% confidence interval (CI): 1.22-2.55]. However, no significant associations were found between PCOS and overall CVD (HR: 1.80, 95% CI: 5.43-9.04), MI (HR: 2.68, 95% CI: 0.69-4.82), or IHD (HR: 2.68, 95% CI: 0.69-4.67). Additionally, there was no significant increase in cardiovascular or all-cause mortality. This meta-analysis highlights that women with PCOS are at an increased risk of stroke, but no conclusive evidence links PCOS to other cardiovascular outcomes or mortality. Clinicians should prioritize stroke prevention in this population. Further large-scale, long-term studies are needed to clarify the cardiovascular risks associated with PCOS.