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Polycystic Ovary Syndrome (PCOS) Awareness Month is a global healthcare event observed annually throughout September, aiming to improve the lives of those affected by PCOS.
PCOS is considered the most common endocrine disorder affecting women in today’s world. Although it has been primarily studied and discussed in terms of its reproductive symptoms, such as infertility, amenorrhea or oligomenorrhea, acne, hirsutism, and mood disorders, there is yet another unexplored and underdiagnosed category in the PCOS spectrum of diseases: its cardio-metabolic consequences.
Cardio-metabolic consequences
Women with PCOS face health risks from an early age, which can increase their chances of illness and even shorten their life expectancy compared to others. The condition develops from a mix of genetic and environmental factors.
In this article, we will explore several cardiovascular risk factors often related to metabolic alterations, such as dyslipidemia, hypertension, endothelial dysfunction, and low-grade chronic inflammation.
Dyslipidemia
Abnormal blood lipid levels are common in PCOS and are characterised by low high-density lipoprotein (HDL) cholesterol, high triglycerides, and sometimes high low-density lipoprotein (LDL) cholesterol.
This condition stems from insulin resistance, hyperandrogenemia, and obesity, which are interconnected within the PCOS metabolic cluster.
Lifestyle changes, such as weight management, are the first line of treatment to manage dyslipidemia and reduce cardiovascular risk in PCOS patients. However, if lifestyle changes alone are insufficient, medications such as statins may be prescribed. These not only help lower “bad” LDL cholesterol but can also provide added benefits, like reducing oxidative stress in the body.
Hypertension
Polycystic ovary syndrome (PCOS) does not just affect hormones and fertility; it also raises the risk of developing high blood pressure (hypertension).
Women with PCOS have a higher risk of developing high blood pressure due to factors like insulin resistance, high androgen levels, an overactive nervous system, blood vessel dysfunction, low nitric oxide levels, and hormonal imbalances.
These changes make it harder for blood vessels to relax, raising blood pressure and increasing the risk of future heart disease.
Regular blood pressure checks and heart health assessments are therefore essential for women with PCOS.
Endothelial dysfunction
Women with PCOS often experience endothelial dysfunction, which means the inner lining of their blood vessels doesn’t work as well as it should. Usually, this lining (called the endothelium) helps blood vessels relax and widen by producing a substance called nitric oxide (NO) to allow blood to flow smoothly.
In PCOS, factors like insulin resistance, chronic inflammation, and high levels of male hormones (androgens) can interfere with this process. When the endothelium makes less nitric oxide, the blood vessels can’t relax properly, causing them to stay narrow.
Over time, this increases strain on the heart and raises the risk of severe heart problems later in life.
Some of the consequences of endothelial dysfunction in PCOS include increased risk of macrovascular disease in women with PCOS and impaired vasodilation, which is a reduced blood vessel dilation in response to stimuli that usually cause them to open, affecting blood flow and vascular health.
Low-grade chronic inflammation
Low-grade chronic inflammation is a common feature of polycystic ovary syndrome (PCOS) and plays a significant role in how the condition develops and progresses.
Women with PCOS often show higher levels of inflammatory markers like C-reactive protein (CRP) and increased white blood cells. This inflammation is partly driven by fat tissue, which releases substances called cytokines that promote inflammation. It’s also closely linked to visceral fat (fat stored around the abdominal organs), a common feature of PCOS that worsens both insulin resistance and hyperandrogenism.
Insulin resistance and inflammation can disrupt the body’s response to insulin, making it more difficult for cells to absorb glucose. Inflammatory signals can trigger the overproduction of androgens, a hallmark of PCOS.
Chronic inflammation can affect the health of the ovaries, interfering with normal egg development and contributing to infertility. This persistent inflammation is also linked to conditions like fatty liver disease, cardiovascular disease, and even depression.
While researchers are still studying the exact mechanisms, it’s clear there’s a complex interplay between inflammation, obesity, insulin resistance, and high androgen levels that drives PCOS.
Because of this, scientists are exploring anti-inflammatory strategies as a potential way to manage PCOS and reduce its long-term complications.
Expert Opinion
DUBAWA spoke with Qudus Lawal, a gynaecologist at Irrua Specialist Teaching Hospital, Edo State. He emphasised that anyone living with PCOS is expected to undergo lifetime education about the condition. According to him, this means adopting healthy lifestyle habits such as eating a balanced diet rich in fruits, vitamins, and antioxidants. He also stressed the importance of regular exercise, mainly because many women with PCOS struggle with insulin resistance.
Beyond lifestyle adjustments, Qudus advised that women with PCOS should go for regular medical checkups and stay in close contact with their doctors.
He said cardio-metabolic diseases associated with PCOS can be managed with prevention, early detection, and treatment. “Management involves preventing complications where possible, detecting any abnormalities early, and treating them promptly,” he noted.
He said that since women with PCOS have a higher risk of developing conditions like type 2 diabetes, hypertension, dyslipidemia (abnormal cholesterol levels), and cardiovascular dysfunction, it is essential for them to be proactive. This involves regular screening and monitoring of their metabolic and cardiovascular functions.
“Whenever an abnormality is detected, specialists should attend to it immediately before it causes major damage,” he said.
Henry Iwunze, a gynaecologist at Simone Hospital, Aba, also explained why women with Polycystic Ovary Syndrome (PCOS) are at greater risk of cardio-metabolic conditions such as diabetes, hypertension, and heart disease.
He said the link lies in metabolic and hormonal changes.
“PCOS increases the risk of diabetes, hypertension, and heart disease primarily through insulin resistance, obesity, especially abdominal fat, dyslipidemia, inflammation, and hormonal imbalances.”
He added that these factors collectively create a “pro-atherogenic, pro-diabetic, and pro-hypertensive state,” which makes women with PCOS more vulnerable to long-term health complications.
Henry emphasised that lifestyle choices remain the most effective tool for managing this condition. “The most effective way women with PCOS can reduce the risk of diabetes, hypertension, and heart disease is through lifestyle interventions such as diet, exercise, and weight loss,” he explained. He further noted that in some cases, medications may be necessary.
Conclusion
PCOS is more than a hormonal condition; it can affect the heart and overall health. With healthy habits, regular checkups, and early treatment, women can lower these risks and live healthier lives.
