Is There Really Increased Cardiovascular Morbidity in Women with Polycystic Ovary Syndrome?

For some time, it has been assumed that women with polycystic ovary syndrome (PCOS) are at increased risk of developing cardiovascular disease (CVD). This has largely been on the basis of having many risk factors, including abnormal lipid profile, insulin resistance, and markers of inflammation. However, despite having these and other risk factors, we argue here, in the view of the authors, that there is no credible evidence that there is greater CVD morbidity in all women with PCOS. We analyze the existing data and discuss that overall CVD risk decreases with age when more CVD events are likely to occur, and introduce the possibility that there may be some unknown inherent protective factor(s) in women with PCOS. It appears that only obesity and/or diabetes mellitus significantly increase CVD risk in women with PCOS, and that most of the data showing an increased rate of CVD are reported in younger women with PCOS where the absolute risk is small. It is also suggested that the CVD risk is predominantly in women with the "classic" features of PCOS, including menstrual irregularity and hyperandrogenism, particularly in the presence of obesity and diabetes, and should not be generalized to all women with PCOS using Rotterdam criteria. Strategies for a healthy lifestyle, which should be a lifelong goal for all women with PCOS, become particularly important to prevent obesity and diabetes.