Polycystic ovary syndrome (PCOS) should be considered not only a reproductive problem but a complex, endocrine, multifaceted disease with important health implications. Several lines of evidence suggest an increased cardiovascular risk and cardiovascular disease characterized by impairment of cardiac structure and function, endothelial dysfunction, lipid abnormalities, and chronic low-grade inflammation. All these features are probably linked to the insulin resistance often present in women with PCOS. Cardiovascular abnormalities represent important long-term sequelae of PCOS that warrant further critical investigation.