Polycystic ovary syndrome (PCOS) is the most common endocrinopathy among women of reproductive age, impacting 5-10% of premenopausal American women. During the reproductive years, women with PCOS seek medical attention related to infertility, hirsutism, and acne. About 60% of women with PCOS are obese and insulin resistant. Up to 40% of women with PCOS will develop diabetes by the age of 50 and many are dyslipidemic. In addition to treating the cosmetic and fertility issues associated with PCOS, health care providers must educate patients regarding the long-term cardiovascular consequences associated the this disorder. At menopause, a woman with PCOS is likely to have had multiple cardiac risk factors for several decades. Postmenopausal women with a history of PCOS, especially those with established diabetes and/or dyslipidemia, should be considered at high risk for the development of clinical cardiac disease. Exercise and a prudent calorie-restricted diet aimed at weight loss must be stressed early. Pharmacologic therapy for diabetes and hyperlipidemia should be used when appropriate. Bariatric surgery, known to positively impact all the aforementioned cardiac risk factors, may also be of benefit.