University of Oulu

Meri-Maija Ollila, Riikka K Arffman, Elisa Korhonen, Laure Morin-Papunen, Stephen Franks, Juhani Junttila, Terhi T Piltonen, Women with PCOS have an increased risk for cardiovascular disease regardless of diagnostic criteria—a prospective population-based cohort study, European Journal of Endocrinology, Volume 189, Issue 1, July 2023, Pages 96–105,

Women with PCOS have an increased risk for cardiovascular disease regardless of diagnostic criteria : a prospective population-based cohort study

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Author: Ollila, Meri-Maija1; Arffman, Riikka K.1; Korhonen, Elisa1;
Organizations: 1Department of Obstetrics and Gynaecology, Medical Research Center Oulu, Research Unit of Clinical Medicine, University of Oulu and Oulu University Hospital, Oulu 90029, Finland
2Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0NN, United Kingdom
3Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu 90014, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.7 MB)
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Language: English
Published: Bioscientifica, 2023
Publish Date: 2023-10-12


Objective: Polycystic ovary syndrome (PCOS) is associated with many cardiovascular disease (CVD) risk factors, such as obesity, type 2 diabetes mellitus and hypertension. However, it remains debatable whether the presence of multiple CVD risk factors translates to increased CVD events.

Desing: A prospective, population-based Northern Finland Birth Cohort 1966.

Methods: Individuals with an expected date of birth in 1966 in Northern Finland have been followed from birth. Women in the cohort were classified as having PCOS according to either the National Institute of Health (NIH) criteria (n = 144) or the Rotterdam criteria (n = 386) at age 31, and they were compared to women without any PCOS features. The study population was re-examined at age 46, and the incidence of major adverse cardiovascular events (MACE), including myocardial infarction (MI), stroke, heart failure and cardiovascular mortality, was recorded up to age 53.

Results: During the 22-year follow-up, both women with NIH-PCOS and women with Rotterdam-PCOS had a significantly higher risk for cardiovascular events than control women. The BMI-adjusted hazard ratio (HR) for MACE in the Rotterdam-PCOS group and the NIH-PCOS group was 2.33 (1.26–4.30) and 2.47 (1.18–5.17), respectively. The cumulative hazard curves in both diagnostic categories began to diverge at age 35. Regarding the individual CVD endpoints, MI was significantly more prevalent in both women with NIH-PCOS (P = 0.010) and women with Rotterdam-PCOS (P = 0.019), when compared to control women.

Conclusions: PCOS should be considered a significant risk factor for CVD. Future follow-up will show how the risk of CVD events develops after menopausal age.

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Series: European journal of endocrinology
ISSN: 0804-4643
ISSN-E: 1479-683X
ISSN-L: 0804-4643
Volume: 189
Issue: 1
Pages: 96 - 105
DOI: 10.1093/ejendo/lvad077
Type of Publication: A1 Journal article – refereed
Field of Science: 3123 Gynaecology and paediatrics
Funding: This study was funded by the Academy of Finland (315921, 321763, Profi6 336449), the Sigrid Juselius Foundation, Diabetestutkimussäätiö, Sakari Alhopuro Foundation, the Medical Research Center Oulu, the Novo Nordisk Foundation and Roche Diagnostics International Ltd. The NFBC1966 31-year follow-up received financial support from the University of Oulu Grant no. 65354, Oulu University Hospital Grant no. 2/97 and 8/97, Ministry of Health and Social Affairs Grant no. 23/251/97, 160/97 and 190/97, the National Institute for Health and Welfare, Helsinki Grant no. 54121 and the Regional Institute of Occupational Health, Oulu, Finland Grant no. 50621 and 54231. The NFBC1966 46-year follow-up received financial support from University of Oulu Grant no. 24000692, Oulu University Hospital Grant no. 24301140 and European Regional Development Fund (ERDF) Grant no. 539/2010 A31592. The data generation, curation and labour were also supported by the following EU H2020 grants: DynaHEALTH (633595), LifeCycle (733206), LongITools (873749), EarlyCause, EDCMET (825762) and the Medical Research Council, UK: grant number MRC/BBSRC MR/ S03658X/1 (JPI HDHL H2020).
EU Grant Number: (633595) DYNAHEALTH - Understanding the dynamic determinants of glucose homeostasis and social capability to promote Healthy and active aging
(733206) LIFECYCLE - Early-life stressors and LifeCycle health
(874739) LONGITOOLS - Dynamic longitudinal exposome trajectories in cardiovascular and metabolic non-communicable diseases
(848158) EarlyCause - Causative mechanisms & integrative models linking early-life-stress to psycho-cardio-metabolic multi-morbidity
(825762) EDCMET - Metabolic effects of Endocrine Disrupting Chemicals: novel testing METhods and adverse outcome pathways
Academy of Finland Grant Number: 321763
Detailed Information: 321763 (Academy of Finland Funding decision)
Copyright information: © The Author(s) 2023. Published by Oxford University Press on behalf of European Society of Endocrinology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.