Heart health in polycystic ovary syndrome: time to act on the data

Polycystic ovary syndrome (PCOS), first described over 80 years ago, is a chronic condition with gynecologic, metabolic, and psychologic manifestations. Both hyperandrogenism and insulin resistance are associated with the high prevalence of cardiometabolic risk factors described in this population. Although robust data in reproductive-age women demonstrate a high rate of obesity, impaired glucose tolerance, hypertension, dyslipidemia, and metabolic syndrome, studies show mixed results in the adolescent and menopausal age groups. There is emerging evidence to support an association between PCOS and nonalcoholic fatty liver disease and obstructive sleep apnea, conditions known to influence cardiovascular disease (CVD) outcomes. Studies from different world regions show an increased risk of subclinical atherosclerosis, measured by a variety of modalities, especially in reproductive-age women. Similarly, there is increasing evidence for a higher prevalence of CVD events, such as stroke, myocardial infarction, and ischemic heart disease. Over the past decade, a number of medical society guidelines have recommended screening women with PCOS for cardiometabolic risk factors for the primary prevention of CVD. This series of Views and Reviews highlights the urgency to implement these guidelines and invest in identifying newer therapies for comprehensively managing the symptoms of PCOS while lowering long-term cardiometabolic risk.