Polycystic ovary syndrome (PCOS) affects an estimated 5–20% of women of reproductive age and is associated with multiple cardiovascular risk factors and atherosclerotic changes. Despite these links, the long-term relationship between PCOS and atherosclerotic cardiovascular disease has not been fully established. This study aimed to evaluate the long-term associated risk of a composite atherosclerotic endpoint—acute myocardial infarction and ischaemic stroke—in women diagnosed with PCOS compared with matched population controls.
Investigators used Danish nationwide registries to identify women diagnosed with PCOS between 1995 and 2024. Each woman with PCOS was matched 1:4 to female controls from the background population by age and year of index, creating a registry-based cohort for long-term follow-up. The total study population comprised 25,513 women with PCOS and 102,052 matched controls. Median age at index was 29.9 years.
Women with PCOS had a higher prevalence of cardiovascular risk factors compared with matched controls. The abstract indicates increased baseline cardiometabolic burden in the PCOS cohort, although specific prevalences and covariate distributions beyond this statement are not detailed in the provided source abstract.
Over follow-up, the 25-year cumulative incidence of the composite outcome (acute myocardial infarction or ischaemic stroke) was higher among women with PCOS compared with controls. The cumulative incidence at 25 years was 3.4% (95% confidence interval [CI] 2.8–4.2%) for women with PCOS versus 2.0% (95% CI 1.8–2.3%) for the control group. Although relative risks were increased, the absolute event rates remained low in both groups over the 25-year horizon.
Cox proportional hazards models demonstrated an increased associated risk of the composite outcome for women with PCOS. The unadjusted hazard ratio (HR) for the composite endpoint was 1.82 (95% CI 1.56–2.11). After adjustment, the HR for the composite outcome remained elevated at 1.53 (95% CI 1.30–1.81). These findings indicate that PCOS is associated with a statistically significant increased long-term risk of major atherosclerotic events, even after accounting for measured covariates in adjusted models reported in the abstract.
When examined separately, both component outcomes showed similar patterns of increased associated risk in women with PCOS. For acute myocardial infarction, the unadjusted HR was 1.86 (95% CI 1.45–2.39) and the adjusted HR was 1.58 (95% CI 1.21–2.07). For ischaemic stroke, the unadjusted HR was 1.83 (95% CI 1.52–2.22) and the adjusted HR was 1.56 (95% CI 1.27–1.91). Thus, both ischemic stroke and myocardial infarction contributed to the higher composite incidence observed in the PCOS cohort.
The authors evaluated whether the observed associations varied by exposure to several commonly used treatments in PCOS. According to the abstract, associations between PCOS and the composite and component outcomes did not differ by use of oral contraception, metformin, anti‑androgens, spironolactone, or glucagon‑like peptide (GLP)-1 analogues. The abstract does not provide stratified HRs or detailed subgroup counts for these medication groups.
In this large, nationwide registry study, women with PCOS had a more than 50% higher associated long-term risk of a composite of acute myocardial infarction and ischaemic stroke compared with matched female controls, after adjustment. Although the relative risks were meaningfully increased, the absolute 25-year risk estimates were low (3.4% vs 2.0%). The investigators conclude these results underscore the potential benefit of early cardiovascular risk assessment and preventive strategies for women with PCOS.
The provided source material is the article abstract and plain language summary. Detailed information on covariates used for adjustment, specific baseline risk-factor prevalences, sensitivity analyses, residual confounding, and a formal limitations section are not included in the abstract text supplied here. Those details would be available in the full article but were not reported in the provided source excerpt.