Association Between Polycystic Ovary Syndrome and Markers of Subclinical Atherosclerosis in Premenopausal Women: A Systematic Review

Background/Objectives: Polycystic ovary syndrome (PCOS) is increasingly recognized as a condition associated with cardiometabolic risk, yet its relationship with subclinical atherosclerosis in premenopausal women remains unclear. This systematic review aimed to synthesize and critically appraise the available evidence on the association between PCOS and markers of subclinical atherosclerosis. Methods: A systematic search of PubMed/MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library was conducted for studies published between January 2021 and January 2026. Eligible studies included premenopausal women with PCOS and assessed direct vascular markers or validated surrogate indicators of subclinical atherosclerosis. Data were synthesized narratively following PRISMA guidelines. Results: Nine studies were included, comprising five human clinical studies and four bioinformatics analyses. Evidence from imaging-based studies demonstrated increased carotid intima-media thickness, reduced wall shear stress, and a higher prevalence of subclinical vascular abnormalities in women with PCOS, particularly in some hyperandrogenic phenotypes. In contrast, adolescent populations showed predominantly metabolic and inflammatory alterations without clear structural vascular changes. Biochemical studies reported adverse lipid profiles and elevated atherogenic markers, while mechanistic studies highlighted inflammatory and mitochondrial pathways. Conclusions: Current evidence suggests that PCOS may be associated with early vascular alterations in premenopausal women; however, findings are limited by heterogeneity and observational designs. Further large-scale, phenotype-stratified prospective studies using standardized vascular assessments are needed to clarify cardiovascular risk in this population.