Polycystic ovary syndrome with stroke, hypertension, and cardiovascular diseases: a systematic review and meta-analysis.

Abstract

Background: Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder among women of reproductive age and has been associated with increased risks of hypertension (HTN), stroke, and cardiovascular disease (CVD). However, the magnitude and consistency of these associations remain unclear due to varying diagnostic criteria, study designs, and population characteristics.

Objective: To systematically review and meta-analyze observational studies evaluating the association between PCOS and the risks of hypertension, stroke, and CVD.

Methods: A systematic literature search was conducted across PubMed, Scopus, Web of Science, Embase, and Cochrane CENTRAL for studies published between January 1, 1990, and January 1, 2025. Eligible studies included cohort, case-control, and cross-sectional designs comparing women with and without PCOS, as defined by established criteria (Rotterdam, NIH, AES, etc.). Data extraction and quality assessment were performed using standardized checklists and the Newcastle-Ottawa Scale. Relative risks (RR) and 95% confidence intervals (CI) were pooled using a random-effects model.

Results: A total of 33 studies on hypertension, 10 on stroke, and 26 on CVD were included. Women with PCOS had significantly increased risk of hypertension (pooled RR: 1.45; 95% CI: 1.32-1.61, I²: 82.20%), stroke (pooled RR: 1.28; 95% CI: 1.10-1.49, I²: 54.09%), and cardiovascular disease (pooled RR: 1.41; 95% CI: 1.17-1.71, I²: 97.05%). The risk of hypertension was most pronounced in cohort studies (RR: 1.47; 95% CI: 1.23-1.76) and in European populations (RR: 1.74; 95% CI: 1.40-2.16). PCOS was also associated with elevated risks of stroke and CVD, independent of body mass index (BMI). Heterogeneity across studies was moderate to high, and no significant publication bias was detected.

Conclusion: PCOS may be linked to an increased risk of hypertension, stroke, and CVD across populations and independent of BMI. Given the high heterogeneity among included studies, these findings should be interpreted with caution. These findings highlight the importance of comprehensive cardiovascular risk assessment and management in women with PCOS. More well-designed, large-scale prospective studies are needed to clarify the underlying mechanisms and improve risk stratification.