Ultimate Guide to Cardiovascular Risk in PCOS

Women with PCOS face higher risks of heart disease, including a twice-as-likely chance of heart attack and a fourfold higher risk of stroke. This is due to hormonal imbalances, insulin resistance, and inflammation. Even women of normal weight with PCOS are affected, making heart health a priority for all.

Key Takeaways:

Insulin Resistance: Affects 65–95% of women with PCOS, leading to diabetes and abnormal cholesterol.
Cholesterol Issues: 70% have dyslipidemia, increasing the chance of atherosclerosis.
Inflammation: Chronic inflammation damages arteries and raises cardiovascular risks.
Testing: Regular lipid panels, glucose tolerance tests, and inflammatory markers like hsCRP are essential.
Lifestyle Changes: Exercise (150–250 minutes weekly) and a heart-healthy, low-glycemic diet can lower risks.
Medications: Options like metformin and statins help manage insulin resistance and cholesterol.

Actionable Steps: Start with regular screenings, adopt healthier eating and exercise habits, and explore medical treatments if needed. Services like Oana Health offer convenient telehealth options to manage PCOS effectively.

Polycystic Ovary Syndrome & Cardiovascular Disease Risk

How PCOS Affects Your Heart Health

Understanding how PCOS impacts your heart can shed light on the risks of heart disease, stroke, and related complications. This condition brings together multiple factors that increase the likelihood of cardiovascular issues. To grasp these risks, it’s helpful to start with a basic understanding of PCOS and how common it is.

What Is PCOS and How Common Is It?

Polycystic ovary syndrome (PCOS) is a hormonal disorder that affects 5–10% of reproductive-age women in the United States. This translates to millions of women dealing with PCOS, making it one of the most prevalent endocrine disorders among women of childbearing age.

PCOS is usually diagnosed based on the Rotterdam criteria, which require at least two of the following three features:

Hyperandrogenism: High levels of male hormones (androgens) that can lead to symptoms like excessive facial hair, male-pattern baldness, or severe acne.
Irregular or absent periods: Often caused by ovulation problems.
Polycystic ovarian morphology: Enlarged ovaries with multiple small cysts visible on an ultrasound.

While PCOS is often associated with reproductive health challenges, its effects go far beyond that. It causes widespread metabolic disruptions, which can have a direct impact on your heart and overall cardiovascular health.

Why PCOS Increases Heart Disease Risk

The connection between PCOS and heart disease stems from several overlapping factors that strain the cardiovascular system.

A major player is insulin resistance, which affects 65–95% of women with PCOS. Insulin resistance leads to higher insulin levels, which can fuel androgen production and create a cycle that worsens both PCOS symptoms and heart risks. This process also triggers inflammation, oxidative stress, and abnormal cholesterol levels, all of which accelerate the development of atherosclerosis.

Women with PCOS are also twice as likely to develop high blood pressure. Elevated blood pressure forces the heart to work harder and can damage arteries over time, increasing the risk of cardiovascular complications.

Chronic low-grade inflammation is another hallmark of PCOS. Elevated markers like C-reactive protein signal ongoing damage to the cardiovascular system, while inflammatory cytokines worsen insulin resistance.

Research backs up these concerns. A large meta-analysis revealed that women with PCOS face a 68% higher risk of any cardiovascular disease, a 48% higher risk of ischemic heart disease, a 150% higher risk of heart attack, and a 71% higher risk of stroke compared to women without PCOS.

"PCOS patients clearly present a higher risk of cardiovascular diseases, linked to metabolic dysfunction due to its peculiar hormonal pattern, characterized by hyperandrogenism, insulin resistance, dyslipidemia, and inflammatory state." – Pietro Scicchitano et al.

The risk of diabetes further complicates the picture. About 35% of women with PCOS have prediabetes, and 10% develop diabetes by age 40. Since diabetes significantly increases the likelihood of heart disease, early detection and management of PCOS are critical. These intertwined factors highlight the hidden cardiovascular risks even in women who appear otherwise healthy.

Heart Risks in Normal-Weight Women with PCOS

One common misconception is that heart risks in PCOS are limited to women who are overweight. However, research shows that metabolic issues tied to PCOS can affect women of all body types.

For instance, insulin resistance is present in lean women with PCOS as well, proving that normal weight doesn’t guarantee lower cardiovascular risk. Studies have also identified endothelial dysfunction in normal-weight women with PCOS. This condition, an early indicator of heart disease, can develop long before any obvious symptoms appear.

Another concerning finding is the prevalence of a non-dipping blood pressure pattern in young, non-obese women with PCOS. Normally, blood pressure drops during sleep, giving the cardiovascular system a chance to recover. However, this pattern is disrupted in 43.4% of PCOS patients, compared to just 3.9% in the general population.

Other markers, such as elevated plasma homocysteine levels, are also linked to heart disease and stroke risk and appear to be independent of body weight in women with PCOS.

Emerging research continues to explore how hormonal imbalances in PCOS affect blood pressure regulation, further emphasizing the importance of close cardiovascular monitoring.

Given these findings, the 2023 International Evidence-Based PCOS Guideline now advises increased awareness of cardiovascular risks in PCOS and calls for comprehensive risk assessments. Regardless of weight, working with knowledgeable healthcare providers to manage PCOS and protect heart health is crucial.

Main Heart Disease Risk Factors in PCOS

PCOS (Polycystic Ovary Syndrome) introduces a range of factors that heighten the risk of heart disease. Understanding these risks is essential for creating effective strategies to protect heart health.

Insulin Resistance and Heart Health

Insulin resistance stands out as a major contributor to cardiovascular issues in PCOS, affecting 65–70% of women with the condition. When the body becomes less responsive to insulin, it compensates by producing more, which not only disrupts blood sugar regulation but also triggers increased androgen production. This hormonal imbalance worsens PCOS symptoms and boosts heart-related risks. Importantly, this issue is not limited to women with obesity; lean individuals with PCOS are also affected.

"Women worry about infertility, acne and weight gain but might not be thinking of high blood pressure and type 2 diabetes. It's important to know that they're at an increased risk and how important diet and exercise is." – Erin Michos, M.D., Associate Director of Preventive Cardiology at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease

Managing insulin resistance starts with lifestyle changes. Prioritize complex carbohydrates like whole grains, legumes, and vegetables while cutting back on refined sugars and processed foods. Adding lean proteins such as poultry, fish, tofu, and legumes can help keep blood sugar levels stable. Exercise is equally vital - aim for at least 30 minutes of moderate activity most days. In some cases, medications like metformin or newer options like GLP-1 agonists may be prescribed to improve insulin sensitivity.

But insulin resistance isn’t the only factor. Lipid imbalances also play a critical role in heart health.

Cholesterol Problems and Abnormal Blood Fats

Dyslipidemia, or abnormal blood fat levels, affects up to 70% of women with PCOS. Studies show that triglyceride levels are approximately 26 mg/dL higher, while HDL (the "good" cholesterol) is 6 mg/dL lower in women with PCOS compared to those without. Additionally, LDL (the "bad" cholesterol) and non-HDL cholesterol levels are elevated by 12 mg/dL and 19 mg/dL, respectively. These imbalances increase the risk of atherosclerosis and heart attacks.

Given these risks, women with PCOS are advised to undergo cholesterol screening every three years instead of the usual five-year interval. Lifestyle adjustments, like regular exercise and adopting a plant-forward, anti-inflammatory diet, are key to managing cholesterol. When medication is necessary, combining it with these lifestyle changes provides the best outcomes.

"Statins will help lower your heart disease risk, but a combination of the medications plus diet is really what will lower overall risk the most... The cholesterol lowering is just one part. You also need to reduce fat accumulation [if you're carrying too many extra pounds], since adipose tissue is a strong driver of inflammation." – Brian Bostick, M.D., Cardiologist at University of Missouri (MU) Health Care

Inflammation and New Risk Markers

Chronic inflammation is another factor that undermines cardiovascular health in women with PCOS. Elevated levels of vascular inflammatory markers, such as highly sensitive C-reactive protein (hsCRP), are common and serve as indicators of potential cardiovascular events. High hsCRP levels suggest damage to arteries and the buildup of plaque.

Additionally, homocysteine - a compound linked to blood vessel damage - is often elevated in women with PCOS and is considered an independent risk factor for cardiovascular disease. High levels of homocysteine can increase the likelihood of clots, heart attacks, and strokes.

To combat inflammation, adopting a heart-healthy diet is crucial. Options like the Mediterranean diet or the American Heart Association diet, which emphasize whole foods, vegetables, fruits, whole grains, lean proteins, and healthy fats, can help reduce inflammation. Adding 150 minutes of moderate exercise each week further supports lower inflammation and better heart health. Together, these strategies provide a solid foundation for reducing cardiovascular risks.

sbb-itb-6dba428

Blood Tests and Monitoring for Heart Risk in PCOS

Keeping an eye on your heart health is especially important if you have PCOS. Regular blood tests can help catch potential cardiovascular issues early, giving you and your doctor the chance to address them before they become serious. Knowing which tests to get and how often to get them can make all the difference in managing your long-term heart health.

Blood Tests to Assess Heart Risks

Certain blood tests are particularly helpful in understanding your cardiovascular risk when you have PCOS. These tests should be a regular part of your health check-ups.

Lipid Panel: This test is essential for evaluating your cholesterol levels, including total cholesterol, LDL ("bad" cholesterol), HDL ("good" cholesterol), and triglycerides. Women with PCOS often have higher LDL-C, VLDL-C, and triglyceride levels, while HDL-C levels are typically lower. For instance, studies indicate that women with PCOS have LDL-C levels that are 9.2 mg/dL higher, non-HDL-C levels that are 16.3 mg/dL higher, and triglycerides that are 26.4 mg/dL higher compared to those without PCOS.
Diabetes Screening Tests: Since PCOS increases the risk of diabetes, screening tests like the OGTT (oral glucose tolerance test) and HbA1c are crucial. These tests measure how your body handles sugar and assess insulin resistance. Research shows that 31% of women with PCOS have impaired glucose tolerance, and 7.5% meet the criteria for type 2 diabetes.
Inflammatory Markers: Tests like highly sensitive C-reactive protein (hsCRP) can reveal inflammation levels in your body. Elevated hsCRP is linked to a higher risk of cardiovascular disease because it signals inflammation that may damage blood vessels and lead to plaque buildup.
Homocysteine Testing: High levels of homocysteine, an amino acid affected by insulin resistance, are considered an independent risk factor for cardiovascular disease. Elevated homocysteine levels can increase the likelihood of blood clots, heart attacks, and strokes.

In addition to blood tests, keeping tabs on your blood pressure is critical. Women with PCOS are twice as likely to develop high blood pressure, so it’s important to have it checked at every medical visit.

"The changed lipid profile levels may contribute to increased cardiovascular risk in PCOS patients." – Dipanshu Sur, MAGS Medical & Research Center

How Often Should You Get Tested?

The frequency of these tests depends on your individual health profile and any previous results. Here’s what experts recommend:

Initial Screening: At the time of your PCOS diagnosis, you should undergo a full lipid panel and diabetes screening with a two-hour oral glucose tolerance test. This provides a baseline for your cardiovascular risk, regardless of your weight or BMI.
Ongoing Monitoring: For most women with PCOS, diabetes screening is recommended every three to five years, or more often if additional risk factors are present. Blood pressure should be checked at every medical visit, while lipid panels and other diabetes tests are typically needed every few years.
More Frequent Testing: If you have specific risk factors - like a family history of diabetes, abnormal cholesterol levels, or plans for pregnancy - you may need more frequent monitoring. Testing may also be increased if your initial results raise concerns or if you start new treatments.
Holistic Monitoring: A well-rounded approach is essential. Regular lipid screenings and follow-ups on cardiovascular markers help manage risks effectively. Early detection of factors like high cholesterol or inflammation can prevent more serious heart issues down the road.

To make testing and monitoring more convenient, telehealth services like Oana Health (https://oanahealth.com) offer personalized care plans, including prescription treatments for insulin resistance and other PCOS-related conditions, with medications delivered straight to your door.

How to Lower Heart Disease Risk with PCOS

Making lifestyle adjustments and using targeted medications can help reduce the risk of heart disease for those with PCOS. It’s about finding the right approach that fits your needs and sticking to it.

Diet and Exercise Changes for Heart Health

Staying active is a cornerstone of managing PCOS and protecting your heart. Regular exercise not only helps regulate hormones and lower testosterone but also improves insulin sensitivity - key factors for heart health.

Experts recommend aiming for 150 minutes of moderate-intensity or 75 minutes of vigorous aerobic exercise each week. That’s roughly 30 minutes a day, five days a week. If weight loss is part of your goal, increasing to at least 250 minutes of moderate activity weekly can provide even greater benefits.

Vigorous aerobic activities are particularly effective for women with PCOS. Research shows that this type of exercise can significantly reduce BMI and insulin resistance. High-intensity interval training (HIIT), which alternates between intense bursts of activity and recovery periods, is another excellent option for boosting cardiovascular fitness.

Incorporate strength training twice a week, as it helps build muscle, boosts metabolism, and reduces both body fat and insulin resistance. Adding stress-relieving exercises like yoga or pilates can further enhance your overall health .

Diet is equally important. If weight loss is a goal, cutting 500 to 1,000 calories per day can make a noticeable difference. Focus on keeping total fat intake below 30% of your daily calories and limit saturated fats to less than 10%.

Opt for low-glycemic carbs - like whole grains and non-starchy vegetables - to stabilize blood sugar levels. Increasing your daily fiber intake by 5 to 10 grams can also help. Eating smaller, more frequent meals every four hours is another way to maintain steady blood sugar.

"If you are diagnosed with polycystic ovary syndrome, it doesn't mean that you are destined to have poor health. There is a lot you can do to take charge, minimize symptoms and keep yourself healthy." - Amanda Stathos, M.S., R.D., L.D.N.

When lifestyle changes alone aren’t enough, medications can provide additional support.

Medications for Managing Heart Risk

If lifestyle adjustments don’t fully address your cardiovascular risks, medications can play a crucial role. Several options are commonly used to help women with PCOS manage heart health.

Metformin is often the first choice. It lowers testosterone levels, reduces hyperandrogenic symptoms, and prevents diabetes in adults. By targeting insulin resistance, metformin addresses one of the main drivers of heart disease risk in PCOS.

Statins are another key option. They not only improve insulin resistance but also lower the risk of heart disease. With about 70% of women with PCOS experiencing abnormal lipid levels, statins can be particularly helpful. Different statins offer specific benefits: for example, atorvastatin improves fasting insulin and insulin sensitivity, while simvastatin is more effective at reducing testosterone.

Both atorvastatin and simvastatin have been shown to reduce inflammation, hyperandrogenemia, and oxidative stress. In one study, simvastatin combined with oral contraceptives improved lipid profiles, reduced systemic inflammation, and lowered androgen levels.

For managing high blood pressure, medications like diuretics, beta-blockers, ACE inhibitors, and calcium channel blockers are effective options.

For women seeking more accessible and personalized care, online treatment platforms offer convenience and expert guidance.

Online Treatment Options for PCOS Management

Telehealth services make it easier than ever to access tailored care for PCOS. Oana Health (https://oanahealth.com) provides personalized prescription treatments delivered straight to your door.

Oana Health offers budget-friendly treatment packs. For example:

Oral Metformin ER: $22/month
Metformin & Spironolactone pack: $32/month
Oral GLP-1 & Metformin pack: $199/month

For those seeking alternative options, topical metformin is available starting at $89/month. This lotion may improve insulin sensitivity with fewer side effects compared to oral forms. One user, Carrie S., shared her experience: "Using Oana's metformin lotion gave me the same benefits as oral metformin, but without the upset stomach and nausea".

After completing a quick online consultation with a licensed medical professional (a $20 doctor’s visit fee), you’ll receive a personalized treatment plan. Medications are then shipped to your home with free delivery.

"Oana's telehealth service is fantastic! It's helped manage my insulin levels and reduce excess hair growth I was experiencing due to PCOS. I'm recommending this to all my friends with PCOS." - Victoria A.

With 1 in 8 women in the U.S. affected by PCOS and facing increased risks of heart disease, heart attacks, and strokes, accessible treatment options are essential for improving long-term health outcomes .

Taking Control of Your Heart Health with PCOS

Managing cardiovascular risks associated with PCOS requires a proactive blend of lifestyle changes and medical care. With 1 in 8 women in the United States affected by PCOS, it’s important to understand and address these risks head-on.

Lifestyle changes are your first line of defense. According to the 2023 International Evidence-Based PCOS Guideline, all women with PCOS - regardless of age or body mass index - should undergo a comprehensive cardiovascular risk assessment. This highlights the importance of taking heart health seriously, even for younger women.

One key focus is weight management, which plays a significant role in improving heart health. Losing just 5% to 10% of your body weight can enhance insulin sensitivity and help restore regular menstrual cycles. Pair this with physical activity: aim for at least 150 minutes of moderate-intensity exercise weekly or increase to 250 minutes per week if weight loss is your goal. These steps create a solid foundation for additional medical interventions if needed.

Regular monitoring is critical. Schedule annual blood pressure checks and an OGTT at diagnosis. If you're at higher risk, these tests may need to be done up to three times a year. Don’t forget to track other key markers like A1C, cholesterol, fasting glucose, triglycerides, and waist circumference to get a full picture of your heart health .

When lifestyle adjustments alone aren’t sufficient, medical interventions can step in. Medications like metformin and statins may be prescribed to manage insulin resistance, cholesterol levels, or blood pressure. The goal is to find the right combination tailored to your specific needs.

Personalized care is more accessible than ever. For example, Oana Health (https://oanahealth.com) offers telehealth services designed specifically for women with PCOS, providing science-based treatments that can be delivered directly to your home.

"The 2023 International Evidence‐Based PCOS Guideline now recommends awareness of increased CVD risk and comprehensive risk assessment in PCOS to help mitigate the burden of CVD in this common and high‐risk condition."

It’s also worth noting that PCOS is a lifelong condition, but it doesn’t have to define your health outcomes. Since more than 50% of individuals with PCOS develop diabetes by age 40, taking action today can help prevent serious complications later on.

A proactive approach includes regular screenings, sticking to lifestyle changes, following your treatment plan, and working with healthcare providers who truly understand PCOS. These steps align with the broader strategies for reducing cardiovascular risks in PCOS and can help safeguard your long-term health.

"Research shows that people with PCOS show evidence of all-over inflammation, which is associated with heart disease and other illness. The Mediterranean diet eliminates saturated fats, processed meats and refined sugar, which makes it a powerful tool to address inflammation." - Amanda Stathos, M.S., R.D., L.D.N., Clinical Dietitian at Johns Hopkins' Sibley Memorial Hospital

FAQs

How does PCOS impact heart health in women who are not overweight?

Even in women who maintain a normal weight, PCOS can pose a serious risk to heart health. This stems from hormonal disruptions such as insulin resistance, hyperandrogenism, and dyslipidemia. These imbalances can trigger inflammation and harm blood vessels, potentially leading to elevated blood pressure and unhealthy cholesterol levels - factors that increase the likelihood of heart disease over time.

What’s crucial to understand is that these cardiovascular risks aren’t solely linked to obesity. Prioritizing regular health check-ups, adopting a heart-friendly diet, and staying active are essential steps in managing these risks and safeguarding your heart.

What are the best lifestyle changes for women with PCOS to lower their risk of heart disease?

Women with PCOS can take steps to lower their risk of heart disease by focusing on a few important lifestyle adjustments:

Get moving: Set a goal of at least 150 minutes of moderate aerobic exercise each week. Activities like walking, cycling, or swimming not only boost heart health but also improve insulin sensitivity.
Choose nourishing foods: Prioritize a diet rich in vegetables, fruits, lean proteins, whole grains, and high-fiber options. A low-glycemic approach can help regulate blood sugar levels and support hormonal balance.
Prioritize stress and sleep management: Incorporate stress-relief practices like yoga or meditation into your routine, and aim for 7–9 hours of restful sleep every night to promote overall wellness.

These practical changes can make a meaningful difference in reducing heart disease risks and enhancing overall health. For tailored, science-based support, Oana Health provides treatments specifically designed for women with PCOS, delivered right to your doorstep.

Why is it important for women with PCOS to monitor their heart health regularly?

Women with PCOS are more likely to experience cardiovascular challenges such as high blood pressure, abnormal cholesterol levels, and insulin resistance. These factors can raise the chances of heart attacks and strokes. Keeping a close eye on heart health can help catch these risks early, making it possible to take steps to avoid severe complications.

By monitoring cardiovascular health, women with PCOS can collaborate with their doctors to address these risks through lifestyle adjustments, medications, or other treatment options. Taking an active role in managing these factors is key to protecting heart health and maintaining overall wellness.