Objective:

To examine the association between polycystic ovarian syndrome (PCOS) and atherosclerotic coronary artery disease (CAD) in women, highlighting its clinical significance.

Key Findings:

• Women with PCOS had a higher 25-year cumulative incidence of acute coronary syndrome and ischaemic stroke (3.4% vs. 2.0% in controls), indicating a significant risk difference.
• PCOS was associated with increased risk of acute myocardial infarction (HR 1.86) and ischaemic stroke (HR 1.83), suggesting a clinically relevant association.
• Recurrent event rates were higher in women with PCOS, both prior to and during follow-up, indicating a need for ongoing monitoring.
• All-cause mortality risk was higher in women with PCOS but not significant after adjusting for comorbidities (HR 1.15), suggesting the need for further investigation.
• The association between PCOS and cardiovascular outcomes persisted despite adjustments for medication use, reinforcing the importance of PCOS as a risk factor.

Interpretation:

The study provides strong evidence that PCOS is associated with increased atherosclerosis risk independent of standard modifiable risk factors, emphasizing the need for targeted cardiovascular risk assessment in women with PCOS and its implications for clinical practice.

Limitations:

• Dataset only included hospital diagnoses, potentially missing milder cases of PCOS, which may limit generalizability.
• Possible overlap in registry coding between PCOS and hirsutism may affect patient inclusion, impacting the study's accuracy.
• Lack of data on PCOS phenotype, imaging, blood results, and body mass index, which are significant confounders.

Conclusion:

The findings underscore the importance of recognizing PCOS as a significant risk factor for atherosclerosis in young women, warranting further research and clinical attention to their cardiovascular health, particularly in identifying effective interventions.