The long-term risks of endometrial hyperplasia and endometrial carcinoma due to chronic anovulation and unopposed estrogen have long been recognised. With increasing awareness of the metabolic abnormalities associated with the syndrome, there is concern regarding cardiovascular risk and other long-term health implications in these women.

Obesity and metabolic abnormalities are recognised risk factors for the development of ischaemic heart disease (IHD) in the general population and these are also recognised features of PCOS. IHD accounts for 18% of deaths in men and 14% of deaths in women in Europe. In men, the incidence of IHD increases after the age of 35 years, while in women an increased incidence is noted after the age of 55 years.

Women with PCOS may be at greater risk for cardiovascular disease because they are more insulin-resistant than weight-matched controls and the metabolic disturbances associated with insulin resistance are known to increase cardiovascular risk in other populations.

Insulin resistance

Insulin resistance is defined as a diminution in the biological responses to a given level of insulin. In the presence of an adequate pancreatic reserve, normal circulating glucose levels are maintained at higher serum insulin concentrations.

In the general population, cardiovascular risk factors include insulin resistance, obesity, glucose intolerance, hypertension and dyslipidaemia. A prospective population-based study of 1462 women aged between 38 and 60 years was undertaken in Gothenberg, Sweden, to examine cardiovascular risk factors in women.