Women with polycystic ovary syndrome (PCOS) are potentially at increased risk of cardiovascular (CV) diseases due to well‐established risk factors, including insulin resistance, obesity and type 2 diabetes mellitus (T2DM). However, data showing excess CV events in this population are still lacking. We investigated the incidence and prevalence of CV events in a cohort of women with PCOS.

Retrospective cohort study (total follow‐up >12 000 person‐years).

Leicester, Leicestershire and Rutland (Total Female population of 434 859), UK.

Two thousand three hundred and one women with PCOS (mean age = 29·6 years) attending a speciality clinic in Leicestershire, UK.

T2DM, myocardial infarction (MI), angina, heart failure (HF), stroke and CV‐related death.

Incidence of T2DM, MI, angina, HF, stroke and CV death was respectively 3·6, 0·8, 1·0, 0·3, 0·0 and 0·4 per 1000 person‐years. At the end of follow‐up, the prevalence of MI in the age groups 45–54, 55–64 and >65 years was 1·9%, 6·0% and 27·3% and of angina was 2·6%, 6·0% and 27·3%, respectively. Age‐group‐specific odds ratios for the prevalence of MI and angina compared to the local female population ranged between 2·6 (95% CI: 1·0–6·3) and 12·9 (CI: 3·4–48·6) with the highest ratio being for MI in the group >65 years old. Age, history of hypertension and smoking had significant correlations with CV outcomes in the PCOS patients.

We have shown a high incidence and age‐group‐specific prevalence of T2DM, MI and angina in the women with PCOS, with over a quarter having had MI or angina in those >65 years. These findings should be considered in the treatment strategies and long‐term planning for women with PCOS.