Women with polycystic ovarian syndrome are at increased associated risk of acute myocardial infarction and ischemic stroke

Background 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. Purpose To examine the long-term associated risk of acute myocardial infarction and ischemic stroke in women with PCOS compared with controls from the background population. Methods 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 ischemic stroke, with the individual components serving as secondary outcomes. Results 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 to controls. The 25-year cumulative incidence of the composite outcome was higher in women with PCOS (3.4% [95%CI 2.8-4.2%]) compared to controls (2.0% [95%CI 1.8-2.3%]), Figure 1. In Cox regression analyses, PCOS was associated with an increased risk of the composite outcome (unadjusted 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 ischemic 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, or GLP1 analogs. Conclusions Women with PCOS were at increased associated risk of acute myocardial infarction and ischemic stroke compared with controls. These findings highlight the potential benefits of early cardiovascular risk assessment and preventive strategies in this population.Figure 1