Bridging the Practice Gap: Polycystic Ovary Syndrome as an Under-Recognised Risk State for Ischaemic Stroke and Cardiovascular Disease
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive-aged women. Epidemiologic evidence increasingly indicates that women with PCOS exhibit elevated risk of ischaemic stroke. Unlike prior reviews that have focused predominantly on general cardiovascular risk in PCOS, this review specifically examines ischaemic stroke risk, its mechanistic links, and the extent to which current stroke and cardiovascular frameworks fail to account for PCOS. We conducted a narrative review examining the association of PCOS on ischaemic stroke and cardiovascular disease (CVD). Large-scale cohort studies and meta-analyses from 2000 to 2025 were identified from Medline, Embase, PubMed, and Google Scholar, with specific emphasis on ischaemic stroke in women with PCOS. Case reports and case series were excluded. There is substantial evidence supporting the relationship between PCOS and increased vascular risk. Large-scale cohort studies and meta-analyses report higher rates of cerebrovascular events among women with PCOS. A recent 2025 meta-analysis pooling 11 studies reported a statistically significantly increased risk of stroke in women with PCOS (OR = 1.89, 95% CI = 1.22-2.55), although heterogeneity was high (I2 = 97.7%), indicating important variation in study design, populations, and confounder adjustment. Other meta-analyses report more modest associations, and some studies did not demonstrate significant associations with myocardial infarction or all-cause…
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