Living with polycystic ovarian syndrome (PCOS) is tough. Your body produces too many “guy hormone” androgens, resulting in irregular periods, acne and hair in all the wrong places. Plus, you’re battling weight gain. And even if you don’t want kids now, you might think about the future and wonder whether your body will cooperate when it comes to making a baby.

As if all that isn’t enough, now doctors are saying women with PCOS need to think about their heart health as well, says Erin Michos, M.D., associate director of preventive cardiology at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease .

“Women worry about infertility, acne and weight gain but might not be thinking of high blood pressure and type 2 diabetes . It’s important to know that they’re at an increased risk and how important diet and exercise is,” says Michos.

The Heart’s Connection to Diabetes and the Ovaries

Many women with PCOS are insulin resistant, meaning that insulin can build up in the body, making it difficult to maintain normal blood glucose levels. This is a risk factor for diabetes, so women with PCOS are especially at risk for developing diabetes as well. In fact, 35 percent of women with PCOS have prediabetes and 10 percent go on to develop diabetes by age 40. Higher androgen levels also increase the risk of diabetes.

Because excess insulin can cause weight gain, women with PCOS also tend to be overweight or obese, particularly in the abdomen area. This belly fat, called visceral fat, can lead to higher triglycerides and lower levels of HDL, or “good” cholesterol.

Heart Disease Risk Factors and PCOS

PCOS risk factors, like being overweight or having insulin-resistant diabetes or higher blood pressure, are associated with cardiovascular disease, says Michos.

“Studies suggest that women with PCOS have a twice as likely risk of a future cardiovascular event, like a heart attack or stroke,” she says.

Diabetes Risk Factors and PCOS

The connection between PCOS and diabetes is not fully understood, but women with PCOS are more likely to develop diabetes if they have these risk factors:

• A family history of diabetes
• Higher blood pressure
• Obesity
• African-American or Hispanic heritage

Healthy Lifestyle Choices to Help Control PCOS

Being diagnosed with PCOS can be daunting, but take heart: You can manage this condition with a healthy lifestyle, says Michos. She urges women who have PCOS to be vigilant about diet and exercise to reduce the risk of diabetes and heart disease.

“Everyone should follow a healthy lifestyle, but especially these women because they’re at greater risk. In general, young women exercise less than young men. They’re not thinking of their heart health; infertility and irregular menstruation are on their minds,” Michos says. “These women need to be extra vigilant.”