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

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.