Could hyperandrogenism in PCOS be cardioprotective?
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Women with PCOS with higher levels of androgens have more microvascular endothelial dysfunction. The problem is, for older women, we are identifying them by their traditional risk factors, so that is what is being captured.

Every woman benefits from lifestyle intervention as a foundational approach. Healthy diet, preventing weight gain or normalizing weight can mitigate risk. BMI may be a mediating factor between PCOS, diabetes and CVD risk. Certainly, assess a woman’s risk. If they already have elevated CV risk, treat with statins. If aged 40 years or older, get a coronary artery calcium score. If BP is elevated, treat based on BP guidelines. We need to make sure these women are screened. Measure their HbA1c, glucose, BP, lipids. We must focus our prevention on these cardiometabolic complications and prevention of type 2 diabetes.

The hyperandrogenic phenotype of polycystic ovary syndrome is the one most closely related to the things we think are “bad” for cardiovascular disease — obesity, insulin resistance — and those seem to be the driving factors of CVD risk.

Source: https://www.healio.com/news/endocrinology/20220411/could-hyperandrogenism-in-pcos-be-cardioprotective
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