Polycystic Ovary Syndrome and Cardiovascular Disease: Pathophysiology, Clinical Evidence, and Preventive Strategies

Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting reproductive-aged women and is increasingly recognized as a condition with significant cardiometabolic implications. Women with PCOS frequently exhibit insulin resistance, dyslipidemia, hypertension, obesity, and chronic low-grade inflammation, all of which contribute to an elevated risk of cardiovascular disease. Subclinical vascular abnormalities, including increased carotid intima-media thickness, coronary artery calcium, and impaired endothelial function, are evident early and may persist into later life. While epidemiologic data suggest an association between PCOS and adverse cardiovascular outcomes, the independent causal relationship remains incompletely defined due to confounding by obesity and metabolic syndrome. Aging and menopause further modify risk, highlighting the need for longitudinal, phenotype-specific research. Current clinical guidelines emphasize early recognition of cardiovascular risk in women with PCOS, advocating for comprehensive screening and preventive strategies, including lifestyle modification and targeted pharmacotherapy. Future studies should clarify long-term outcomes and determine whether early intervention can reduce lifetime cardiovascular burden in this population.