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This review systematically addresses the evidence confirming polycystic ovary syndrome (PCOS) as a cardiovascular health threat. Literature in this area is void of long-term prospective studies to adequately evaluate outcome, but there is important evidence using surrogate markers for future development of and presence of cardiovascular disease and diabetes in women with PCOS. In addition, this article reviews the evidence regarding evaluation and management of cardiovascular risk factors in the population of women with PCOS. We seek to review the literature to determine when or if recommendations for management of women with PCOS should deviate from guidelines for the population at large.