What to Know About PCOS and Heart Disease

Living with PCOS (polycystic ovary syndrome) can feel like a lot to manage, especially when your symptoms touch so many parts of your health. You may already know how this endocrine disorder affects your hormones and menstrual cycle, but PCOS can also influence your long‑term heart health. In fact, it raises your risk for both heart disease and stroke.

With PCOS, you have seven times the risk of cardiovascular disease and four times the risk of stroke, compared to women who don’t have PCOS. Understanding why can help you take small, steady steps to protect your health.

PCOS is linked to heart disease risk factors including:

• Abnormal cholesterol levels. PCOS is linked with high triglycerides and LDL cholesterol and low HDL cholesterol.
• High blood pressure. Risk is higher for women with PCOS during the childbearing years. It’s increased further for women who are obese.
• High levels of male hormones. High androgen levels are responsible for the facial hair growth you may see with PCOS.
• Insulin resistance/prediabetes. This is the most common heart disease risk factor linked with PCOS. It’s very common in overweight and obese women but also found in more than half of women who are at normal weight.
• Obesity and excessive abdominal fat. The hormonal imbalances that accompany PCOS can make it more likely that you gain weight.
• Type 2 diabetes. If prediabetes isn’t treated and controlled, it can develop into type 2 diabetes.

What to Talk to Your Doctor About

If you have PCOS, you’ll want to talk to your doctor about screening for heart disease.

• Have your blood pressure checked every year or more often if your doctor recommends it.
• Have a annual electrocardiogram to screen for cardiovascular disease.
• Talk to your doctor about cholesterol and diabetes testing every two years, even if you’re young.
• Talk to your doctor about testing for calcium deposits in your arteries, which are a warning sign of heart attack risk. Women with PCOS who are as young as 30 may have these deposits.
• Your doctor may want to measure your height and waist circumference and monitor changes in your body mass index.
• Your doctor may recommend checking the thickness of your carotid artery, since a thick artery is linked with higher risk of cardiovascular disease.

Reduce Your Heart Disease Risk

If you have PCOS, it’s especially important to make heart-healthy lifestyle choices:

• Watch your diet. Choose vegetables and fruits, whole grains, lean protein and healthy fat. Limit added sugars and refined grains. Consider following the Mediterranean diet, or talking to a dietitian at Sutter for personalized nutrition guidance.
• Don’t smoke or vape. Nicotine is bad for your cardiovascular system. It’s especially risky if you have PCOS and high cholesterol.
• Exercise often. Aim to walk, bike or get some type of cardio exercise for 150 minutes a week, and ideally, 30 minutes a day.
• Reduce stress. Try mindfulness, deep breathing, meditation, yoga or quiet time doing something you enjoy.
• Manage your weight. Try to lose weight if you need to and to maintain a healthy weight.

When Treatment Is Needed

If lifestyle changes aren’t reducing your risk of heart disease with PCOS, your doctor may recommend medications that can help. If you use medication, it should go along with, not in place of, lifestyle changes.

• Cholesterol: Medications can help shift your cholesterol levels to healthier ranges.
• Diabetes: Metformin and GLP-1 receptor antagonist medications (Ozempic®, Wegovy®, Mounjaro®, Zepbound™) can help you control your blood sugar levels.
• Oral birth control: Hormonal contraceptives may help control PCOS symptoms and reduce heart disease risk.