Abstract Body (Do not enter title and authors here): Background: Polycystic ovarian syndrome (PCOS) is associated with increased cardiovascular risk factors, but racial disparities in cardiovascular outcomes among women with PCOS remain incompletely characterized. This study evaluated racial differences in cardiovascular outcomes between Black and White women with PCOS.

Hypothesis: We hypothesized that Black women with PCOS would exhibit a higher incidence of major adverse cardiovascular outcomes, including myocardial infarction and heart failure, compared to White women with PCOS, reflecting racial differences in cardiometabolic burden and disease progression.

Methods: This retrospective cohort study utilized electronic medical records from the TriNetX Global Collaborative Network. All participants were females aged 18-50 years with confirmed PCOS diagnosis. After propensity score matching, Black women with PCOS (n=16,894) were compared with matched White women with PCOS (n=16,894) over a 10-year follow-up period.

Results: Black women with PCOS demonstrated significantly higher risk of myocardial infarction (RR 2.417, 95% CI 1.568-3.723, p<0.001), heart failure (RR 2.244, 95% CI 1.704-2.955, p<0.001), and cardiovascular death (RR 1.623, 95% CI 1.153-2.284, p=0.005) compared to White women with PCOS. Additionally, Black women had significantly higher incidence of hypertension (RR 1.531, 95% CI 1.429-1.641, p<0.001), type 2 diabetes mellitus (RR 1.735, 95% CI 1.596-1.886, p<0.001), and hyperlipidemia (RR 1.143, 95% CI 1.054-1.239, p=0.001). No significant racial differences were found in ischemic stroke (RR 1.334, 95% CI 0.683-2.604, p=0.397) or atrial fibrillation (RR 1.084, 95% CI 0.764-1.539, p=0.651).

Conclusion: Black women with PCOS experience significantly higher rates of adverse cardiovascular outcomes compared to White women with PCOS, including more than twice the risk of myocardial infarction and heart failure. These findings highlight substantial racial disparities in cardiovascular outcomes among women with PCOS and underscore the need for targeted preventive strategies and closer cardiovascular monitoring in Black women with PCOS.