A Study Of 2.4 Million Women Just Uncovered A Hidden Heart Risk & Most Don't Know They Have It
If you have PMOS—recently renamed from PCOS (polycystic ovary syndrome)—you've likely spent a lot of time thinking about hormones, cycles, and fertility. Heart health probably hasn't been part of that conversation.
But new research1 tracking more than 2.4 million women over two decades found that women with PMOS have more than four times the risk of a serious cardiovascular event compared to women without the condition, even after accounting for factors like diabetes, high blood pressure, and obesity.
It's the largest study of its kind, and it makes a strong case for why heart health needs to be part of PMOS care from the start.
About the study
PMOS affects roughly 1 in 8 women worldwide. The condition disrupts hormone balance, causing higher-than-normal levels of androgens (sex hormones that women produce in small amounts), irregular ovulation, and often making the body less responsive to insulin.
Researchers have long suspected it raises the risk of heart disease, but earlier studies were too small or set up too differently from each other to give a clear answer.
This study was built to finally settle the question. Researchers analyzed records from 413,450 women with PMOS, drawn from a large U.S. health insurance database covering 2000 to 2022.
Each woman with PMOS was matched with five women without the condition, and both groups averaged 31 years old.
The researchers were specifically looking for signs of cardiovascular disease, including coronary artery disease (reduced blood flow to the heart), stroke, and peripheral artery disease (reduced blood flow to the limbs).
Women with PMOS had a 4.4-fold higher risk of heart disease
Even after researchers accounted for a long list of known heart disease risk factors (diabetes, obesity, high blood pressure, elevated cholesterol, sleep apnea, depression, infertility, smoking, and medication use), women with PMOS were still more than four times as likely to experience a serious cardiovascular event as women without the condition.
When researchers dug into why that risk was so elevated, those traditional risk factors only explained about a third of it.
The other two-thirds remained unexplained, which suggests PMOS itself is doing something to the cardiovascular system that goes beyond the conditions it's known to cause.
Why PMOS affects the heart
Several of PMOS's core features put the cardiovascular system under sustained stress, often starting in a woman's 20s and 30s:
- Insulin resistance: When the body doesn't respond well to insulin (the hormone that regulates blood sugar), it produces more of it, which in turn drives higher androgen levels. This cycle worsens both PMOS symptoms and heart risk.
- Elevated androgens: Higher levels of androgens are linked to inflammation in blood vessels and unfavorable cholesterol shifts, including lower HDL ("good" cholesterol) and higher LDL ("bad" cholesterol).
- Chronic inflammation: Low-grade, persistent inflammation can damage blood vessel walls over time and contribute to plaque buildup in the arteries.
- Abnormal cholesterol and triglycerides: Women with PMOS are more likely to have lipid (fat) levels that further accelerate plaque formation.
What this means if you have PMOS
PMOS has long been treated as a reproductive condition, but this research makes a strong case that the heart needs to be part of the picture too.
The 2023 International PMOS Guidelines already recommend that all women with PMOS get a cardiovascular risk assessment at diagnosis, regardless of age or weight. This study adds real weight to that recommendation.
Having PMOS doesn't mean heart disease is inevitable. It means your heart deserves the same attention as your hormones. A few things worth bringing up with your provider:
- Cardiovascular monitoring: Routine checks for blood pressure, cholesterol, and blood sugar are worth starting in your 20s and 30s, not waiting until midlife.
- Movement: Regular exercise supports insulin sensitivity and keeps inflammation in check. Combining cardio and strength training tends to offer the most benefit for heart health.
- Diet: Focus on foods that keep blood sugar steady, including vegetables, legumes, whole grains, and quality protein sources.
- Know your numbers: Key blood tests, including fasting blood sugar and cholesterol, give you a baseline and help you spot any shifts early.
The takeaway
PMOS is a whole-body condition, and this research makes clear that cardiovascular health belongs in the conversation alongside hormones and cycles.
Women with PMOS had more than four times the risk of a serious heart event, even after accounting for traditional risk factors like diabetes and high blood pressure. If you have PMOS, early cardiovascular monitoring isn't an overreaction. It's exactly the kind of proactive care the evidence now supports.