Is PCOS/PMOS associated with an increased risk of Cardiovascular Disease?
The findings from a new Study (published 20 July 26) in The Lancet Obstetrics, Gynaecology, & Women’s Health concluded females diagnosed with PMOS have a ‘significantly higher’ incidence of atherosclerotic cardiovascular disease events.
The analysis of more than 2.4 million women in the United States, investigating data over a 22-year period, of 413,000 PMOS patients aged 18–50 identified a 4 fold increase in heart disease risk.
Does PMOS Increase the Risk of Heart Disease?
The short answer is that PMOS is associated with a higher burden of cardiovascular risk factors, and research has raised concerns about increased long-term cardiovascular disease risk.
However, it is important to distinguish between:
- Cardiovascular risk factors, such as high blood pressure, abnormal cholesterol, insulin resistance and diabetes; and
- Actual cardiovascular events, such as heart attack, stroke or coronary artery disease.
The evidence linking PMOS/PCOS with cardiovascular disease is complex. Some studies have found increased cardiovascular risk, while the size of the association varies depending on the population studied, age, menopause status, duration of follow-up and how cardiovascular disease is defined.
The 2023 International Evidence-Based Guideline for the Assessment and Management of PCOS — which remains an important evidence base as terminology transitions to PMOS — recommends that all women with PCOS be assessed for cardiovascular disease risk factors.
The guideline recommends a lipid profile at diagnosis regardless of age, weight, BMI and recommends blood pressure measurement at least annually and when planning pregnancy or fertility treatment. It also recognises the potential importance of PMOS/PCOS as a cardiovascular risk factor in broader cardiovascular risk assessment.
This means that cardiovascular prevention should be part of routine PMOS care.
At Crown St Medical Centre, our Surry Hills doctors and GPs believe women should be supported to understand their individual cardiovascular risk rather than relying on a single population-level statistic or studies.
Why Might PMOS Be Associated With Heart Disease?
There is unlikely to be one single explanation.
PMOS is a complex condition involving hormonal, metabolic and potentially inflammatory pathways. Several factors may interact over many years to influence cardiovascular health.
- Insulin Resistance
Insulin resistance is common in PMOS and can occur in women across the BMI spectrum.
When the body’s tissues become less responsive to insulin, the pancreas may compensate by producing more insulin. Over time, insulin resistance can contribute to:
- Higher blood glucose levels
- Prediabetes
- Type 2 diabetes
- Increased abdominal fat
- Abnormal cholesterol patterns
- Increased triglycerides
- Higher blood pressure
These are all relevant to cardiovascular health.
Importantly, a woman can have insulin resistance without knowing it. She may feel completely well while metabolic changes gradually develop.
This is one reason why regular GP assessment is important for women with PMOS.
- Abnormal Cholesterol and Triglycerides
Some women with PMOS have an adverse lipid profile, which may include:
- Higher LDL cholesterol
- Higher triglycerides
- Lower HDL cholesterol
- Other changes in lipid metabolism
Over time, unhealthy cholesterol levels can contribute to atherosclerosis — the gradual build-up of fatty plaques within arteries.
The international PMOS/PCOS guideline recommends obtaining a lipid profile at diagnosis, with subsequent testing based on the results and the woman’s broader cardiovascular risk profile.
A cholesterol test is simple, but it can provide valuable information about long-term cardiovascular risk. It can be readily organised by our Surry hills doctors and GP team.
- High Blood Pressure
High blood pressure is another major risk factor for heart attack, stroke and kidney disease.
Women with PMOS may be more likely to develop hypertension, particularly when other metabolic risk factors are present.
High blood pressure is often called a “silent” condition because many people have no symptoms.
The international guideline recommends blood pressure measurement at least annually for women with PMOS/PCOS and when planning pregnancy or fertility treatment.
At Crown St Medical Centre, routine blood pressure monitoring can form part of your ongoing GP care.
- Type 2 Diabetes and Prediabetes
PMOS is strongly associated with abnormalities in glucose metabolism.
Insulin resistance can increase the risk of:
- Prediabetes
- Type 2 diabetes
- Gestational diabetes during pregnancy
Diabetes is itself a major cardiovascular risk factor.
The Australian Heart Foundation notes that high blood pressure, high cholesterol and diabetes all increase the likelihood of heart disease, and that managing these conditions is an important component of prevention.
For women with PMOS, checking glucose metabolism is therefore not simply about preventing diabetes. It is also part of protecting long-term cardiovascular health.
Depending on your individual circumstances, your GP may recommend a blood glucose test or an oral glucose tolerance test.
- Weight Gain and Central Adiposity
Weight is a complex issue in PMOS.
Some women with PMOS have overweight or obesity, while others have a normal BMI. It is therefore important not to assume that cardiovascular risk is determined by body weight alone.
When excess body fat is present — particularly around the abdomen — it can be associated with:
- Increased insulin resistance
- Higher blood pressure
- Abnormal cholesterol
- Increased inflammation
- Higher risk of type 2 diabetes
For women who would benefit from weight reduction, even modest, sustainable improvements may have positive effects on metabolic health.
The goal should not be rapid or extreme weight loss. Instead, management should focus on an individual’s overall health, nutrition, physical activity, metabolic profile and personal circumstances.
- Chronic Low-Grade Inflammation
Researchers have explored whether chronic low-grade inflammation may contribute to the association between PMOS and cardiovascular disease.
Inflammation is involved in the development and progression of atherosclerosis.
However, the relationship is complex. It is not yet clear how much of the cardiovascular risk associated with PMOS is directly attributable to inflammation and how much is mediated through insulin resistance, adiposity, diabetes, hypertension and other factors.
This is an active area of research.
- Hormonal and Androgen-Related Factors
PMOS can involve elevated androgen levels or increased androgen activity.
Androgens may interact with insulin resistance, body composition and other metabolic pathways.
Some research has suggested that androgen excess may contribute independently to cardiovascular risk, although the precise mechanisms remain under investigation.
This is another reason why PMOS should be viewed as a complex endocrine condition rather than solely a disorder of reproductive health.
- Sleep Apnoea
Obstructive sleep apnoea is more common in women with PMOS, particularly where overweight or obesity is present.
Sleep apnoea can contribute to:
- High blood pressure
- Insulin resistance
- Daytime fatigue
- Poor sleep quality
- Metabolic dysfunction
If you snore heavily, wake feeling unrefreshed, experience morning headaches or feel excessively sleepy during the day, speak with your GP.
Assessment and treatment of sleep apnoea may be an important part of comprehensive PMOS care.
- Pregnancy-Related Cardiovascular Risk
PMOS can be associated with increased risks during pregnancy, including gestational diabetes and hypertensive disorders of pregnancy.
These pregnancy complications are relevant beyond pregnancy itself because conditions such as pre-eclampsia and gestational diabetes can be associated with increased cardiovascular risk later in life.
The Australian Heart Foundation also recognises pregnancy complications such as pre-eclampsia and gestational diabetes as important female-specific cardiovascular risk factors.
Women with PMOS who are planning pregnancy should discuss their health with their GP before conception where possible.
What Heart Health Screening Should Women With PMOS Consider?
There is no single “PMOS heart test” that can predict whether an individual woman will develop heart disease.
Instead, cardiovascular prevention involves building a complete picture of your health.
Your GP may consider:
Blood pressure
Regular blood pressure measurement is recommended as part of PMOS care.
Cholesterol
A lipid profile can assess total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides.
Blood glucose
Your GP may recommend testing for prediabetes or diabetes based on your individual risk factors.
Weight and waist circumference
Weight trends and central adiposity can provide useful information about metabolic health, although BMI alone does not define cardiovascular risk.
Smoking status
Smoking is one of the most important modifiable cardiovascular risk factors.
If you smoke or vape nicotine, your GP can discuss evidence-based strategies to help you quit.
Family history
Tell your GP if close relatives have experienced:
- Heart attack
- Stroke
- High cholesterol
- Diabetes
- High blood pressure
- Cardiovascular disease at a young age
Physical activity
Your GP can discuss how active you are and identify realistic ways to increase movement.
Diet and nutrition
A dietary assessment can help identify opportunities to improve metabolic and cardiovascular health.
Sleep
Symptoms of obstructive sleep apnoea should be considered, particularly where risk factors are present.
Mental health
Depression, anxiety and psychological distress can coexist with PMOS and may affect lifestyle, sleep and overall wellbeing.
Comprehensive care should address the whole person.
Should Women With PMOS Have a Heart Health Check?
In Australia, the Heart Foundation recommends cardiovascular risk assessment for eligible adults, generally including people aged 45–79 without known cardiovascular disease, with earlier assessment for some groups such as people with diabetes and First Nations Australians.
The Australian CVD Risk Calculator is used to estimate the risk of a cardiovascular event over the next five years in eligible adults.
However, women with PMOS do not necessarily need to wait until the standard age for population-based cardiovascular risk assessment before discussing their heart health.
The international PMOS/PCOS guideline specifically recommends assessing cardiovascular risk factors in women with PMOS and checking lipids at diagnosis and blood pressure annually.
The important distinction is that risk-factor screening is not the same as formal population cardiovascular risk calculation.
A younger woman with PMOS may have:
- High blood pressure
- Abnormal cholesterol
- Prediabetes
- Diabetes
- A strong family history
- Smoking exposure
- Significant obesity
- Sleep apnoea
Even if she is too young for routine Australian absolute cardiovascular risk calculation, these factors still deserve attention.
The Heart Foundation also emphasises that high blood pressure, high cholesterol and diabetes can substantially increase cardiovascular risk and that lifestyle changes and appropriate medical treatment can reduce risk.
Book an Appointment Online
Book an appointment with Crown St Medical Centre today to discuss PMOS, PCOS, cardiovascular risk, metabolic health, weight management or your broader women’s health needs.
If you live in Surry Hills, Darlinghurst, Paddington, Redfern, Waterloo, Woollahra or Green Square, our experienced Male and Female Surry Hills Doctors / GP team can help you understand your individual risk factors and develop a personalised plan focused on prevention, early detection and long-term health.
In the next article, our Surry Hills doctors & GPs discuss how you can manage the Risk Factors.
Last medically reviewed: 2 August 2026
Reviewed by: Doctors at Crown St Medical Centre – Surry Hills Doctors & GPs
Location: Crown Street, Surry Hills NSW
