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. 2025 Aug 30:zwaf351.
doi: 10.1093/eurjpc/zwaf351. Online ahead of print.

Polycystic ovarian syndrome and long-term risk of acute myocardial infarction and ischaemic stroke

Eva Havers-Borgersen  1   2 , Charlotte Ekelund  3   4 , Pernille Fog Svendsen  5 , Marie S Reinert  1 , Helene Vistisen  1 , Jawad H Butt  1   2 , Lauge Østergaard  1 , Morten Schou  4   6 , Lars Køber  1   4 , Emil L Fosbøl  1   4
Affiliations

Polycystic ovarian syndrome and long-term risk of acute myocardial infarction and ischaemic stroke

Eva Havers-Borgersen et al. Eur J Prev Cardiol. .

Abstract

Aims: Polycystic ovary syndrome (PCOS) affects 5-20% of reproductive-aged women and is linked to cardiovascular risk factors and atherosclerosis. Yet, its long-term association with atherosclerotic cardiovascular disease remains uncertain and will be the focus of this study.

Methods and results: Women diagnosed with PCOS (1995-2024) were identified through Danish nationwide registries and matched 1:4 with female controls from the background population by age and year of index. The primary outcome was a composite of acute myocardial infarction and ischaemic stroke, with the individual components serving as secondary outcomes. The study included 25 513 women with PCOS and 102 052 matched controls (median age 29.9 years). Women with PCOS had a higher prevalence of cardiovascular risk factors compared with controls. The 25-year cumulative incidence of the composite outcome was higher in women with PCOS [3.4% (95% confidence interval (CI) 2.8-4.2%)] compared with controls [2.0% (95% CI 1.8-2.3%)]. In Cox regression analyses, PCOS was associated with an increased risk of the composite outcome [unadjusted hazard ratio (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 ischaemic stroke [unadjusted HR 1.83 (95% CI 1.52-2.22), adjusted HR 1.56 (95% CI 1.27-1.91)]. The associations did not vary by use of oral contraception, metformin, anti-androgens, spironolactone, or glucagon-like peptide (GLP)-1 analogues.

Conclusion: Women with PCOS were at increased associated risk of acute myocardial infarction and ischaemic stroke compared with controls. While absolute risks were low, these findings highlight the potential benefits of early cardiovascular risk assessment and preventive strategies in this population.

Keywords: Atherosclerotic cardiovascular disease; Epidemiology; Female-specific risk factors; PCOS; Polycystic ovary syndrome.

Plain language summary

Women with polycystic ovary syndrome (PCOS) have a higher long-term associated risk of heart attack and stroke compared with those without the condition.Women with PCOS have a more than 50% higher associated risk of developing severe heart-related conditions, including heart attacks and strokes, over 25 years compared with those without PCOS.While the absolute risk remains low, these findings highlight the importance of early cardiovascular risk screening and prevention for women with PCOS.

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Conflict of interest statement

Conflict of interest: L.K. has received speaker honorariums from Astra Zeneca, Boehringer, Novartis, and Novo. None of the other authors has any declarations to make.

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