Polycystic ovary syndrome (PCOS) is a heterogeneous and common syndrome with features and characteristics that affect women throughout their lifespan, often decreasing reproductive ability and quality of life, and increasing other types of morbidity and mortality, in particular cardiovascular disease. It is often undiagnosed and untreated with large gaps in care despite evidence-based guidelines. Estimates of prevalence, diagnosis, and studies of management strategies are limited by inclusion bias, varying definitions and phenotypes of PCOS, and the exclusion of older women. Note that the very term “cystic” is a misnomer; the reference is to “arrested follicles” within the ovary and not cysts.1

The current management guidelines for PCOS now include a focus on identifying and treating cardiovascular and cardiometabolic disease risk factors including dyslipidemia, hypertension, overweight and obesity. In addition, management is now viewed as enduring and should continue over a woman's lifespan as the hormonal and cardiometabolic abnormalities often continue after menopause.

This review provides an expanded perspective on PCOS with a special focus on cardiometabolic disorders and dyslipidemia in the context of the increased risk for atherosclerotic cardiovascular disease (ASCVD). Given the complexities of PCOS, management is best conducted by a multi-disciplinary team, alert to all its facets. Specialists in cardiometabolic and lipid disorders can play an integral part in the care of women with PCOS.