LAUSR

OBJECTIVES Compare cardiometabolic trajectories of 557 parous women with diagnosed, probable, and no polycystic ovary syndrome (PCOS) throughout 15y follow-up (2002 to 2021). METHODS We defined PCOS status as: (1) clinically diagnosed; (2) probable: without diagnosis but ≥2 of the following: cycle length<21 or ≥35 days, free testosterone>75th %ile, or anti-Müllerian hormone>75th %ile; (3) no PCOS. Outcomes included longitudinal adiposity, blood pressure, lipids, glycemia, and adipokines. We used mixed-effects models to examine associations of PCOS status with the outcomes, adjusting for covariates. RESULTS Women were 37±5y at baseline; 9.7% had diagnosed and 9.2% probable PCOS. Throughout follow-up, women with diagnosed vs. no PCOS had higher adiposity, systolic blood pressure, triglycerides, hemoglobin A1c, fasting glucose, insulin, and leptin; and lower high-density lipoprotein and adiponectin. However, the diagnosed and probable PCOS groups had similar hemoglobin A1c (0.16 [95% CI: -0.20, 0.52]), leptin (-4.20 [-16.61, 8.22] ng/mL), and adiponectin (0.99 [-2.15, 4.13] μg/mL). Both groups had less favorable profiles than women without PCOS, even after body mass index adjustment. CONCLUSION Although women with diagnosed PCOS have the least favorable cardiometabolic profile throughout mid-life, those with probable PCOS exhibited comparable glycemia and an altered adipokine pattern suggestive of adipocyte dysfunction independent of adiposity.