Cardiovascular-kidney-metabolic risk in polycystic ovary syndrome: a risk-oriented perspective from integrated Chinese-Western medicine

Polycystic ovary syndrome (PCOS), recently proposed to be renamed polyendocrine metabolic ovarian syndrome (PMOS), is a common reproductive endocrine disorder in women of reproductive age with substantial metabolic heterogeneity and important long-term cardiovascular and kidney implications. Cardiovascular-kidney-metabolic (CKM) syndrome provides a stage-based framework for understanding the progression from dysfunctional adiposity and metabolic risk clustering to subclinical target-organ injury and overt cardiovascular and kidney disease. This review summarizes the epidemiological, clinical, and mechanistic evidence linking PCOS with the CKM continuum. Women with PCOS frequently exhibit obesity, insulin resistance (IR), type 2 diabetes mellitus, metabolic dysfunction-associated steatotic liver disease, dyslipidemia, hypertension, and metabolic syndrome, which may contribute to progression from CKM stages 1-2 toward stages 3-4. PCOS is also associated with subclinical cardiovascular abnormalities, cardiovascular events, glomerular hyperfiltration, tubular injury, and increased kidney risk, with additional vulnerability during pregnancy, the postpartum period, and the menopausal transition. Mechanistically, IR, adipose tissue dysfunction, and hyperandrogenemia constitute major upstream abnormalities, while chronic low-grade inflammation and oxidative stress contribute to downstream tissue injury; gut microbiota dysbiosis and epigenetic remodeling may further modify this process. Based on these findings, we propose the “cardio-renal-metabolic-ovarian axis” as an integrative, hypothesis-generating framework linking ovarian endocrine dysfunction, systemic metabolic amplification, and cardio-renal target-organ injury. We further propose CKM stages 2-3 as a potential window for PCOS-specific integrated Chinese-Western prevention, combining lifestyle intervention, metabolic risk control, early cardio-renal screening, evidence-based pharmacotherapy, and adjunctive traditional Chinese medicine (TCM). Prospective studies are needed to validate PCOS-specific CKM risk stratification and determine whether earlier intervention improves long-term cardiovascular and kidney outcomes.