The relationship between polycystic ovary syndrome (PCOS) and subclinical atherosclerosis remains unclear. We performed a comprehensive systematic review and meta-analysis to evaluate the effect of PCOS on functional and structural markers of subclinical atherosclerosis as measured by carotid intima-media thickness (cIMT), flow-mediated vasodilation (FMD), nitroglycerin-mediated vasodilation (NMD), pulse wave velocity (PWV), and coronary artery calcium (CAC). Standard mean differences (SMDs) or odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were calculated. Ninety-six articles involving 5550 PCOS patients and 5974 controls were included. Compared with controls, PCOS patients showed significantly thicker cIMT (SMD (95% CI) = .587 (.398, .776), P < .001), lower FMD (SMD (95% CI) = −.649 (−.946, −.353), P < .001) and NMD (SMD (95% CI) = −.502 (−.686, −.317), P < .001), as well as higher PWV (SMD (95% CI) = .382 (.019, .746), P = .039), and increased CAC incidence (OR (95% CI) = 2.204 (1.687, 2.879), P < .001). When analyzing subgroups by age and body mass index (BMI), results were still significant (P < .05) except for PWV in the BMI subgroup. There was no significant result on sensitivity analysis, and Begg’ test or Egger’s test. PCOS contributes to subclinical atherosclerosis, resulting in functional and structural changes in cIMT, FMD and NMD, PWV, and CAC incidence.
JeanesYMReevesS. Metabolic consequences of obesity and insulin resistance in polycystic ovary syndrome: diagnostic and methodological challenges. Nutr Res Rev2017; 30: 97–105.
3.
WildRACarminaEDiamanti-KandarakisE, et al.Assessment of cardiovascular risk and prevention of cardiovascular disease in women with the polycystic ovary syndrome: a consensus statement by the androgen excess and polycystic ovary syndrome (AE-PCOS) Society. J Clin Endocrinol Metabol2010; 95: 2038–2049.
4.
KaroliRMainiSSiddiqiZ, et al.Study of early atherosclerotic markers in women with polycystic ovary syndrome. Indian J Endocrinology and Metabolism2012; 16: 1004–1008.
5.
MeunCGunningMNLouwersYV, et al.The cardiovascular risk profile of middle aged women with polycystic ovary syndrome. Clin Endocrinol2020; 92: 150–158.
6.
de GrootPCMDekkersOMRomijnJA, et al.PCOS, coronary heart disease, stroke and the influence of obesity: a systematic review and meta-analysis. Hum Reprod Update2011; 17: 495–500.
7.
LegroRS. Polycystic ovary syndrome and cardiovascular disease: a premature association?Endocr Rev2003; 24: 302–312.
8.
TripathyPSahuASahuMNagyA. Ultrasonographic evaluation of intra-abdominal fat distribution and study of its influence on subclinical atherosclerosis in women with polycystic ovarian syndrome. Eur J Obstet Gynecol Reprod Biol2017; 217: 18–22.
9.
SprungVSJonesHPughCJA, et al.Endothelial dysfunction in hyperandrogenic polycystic ovary syndrome is not explained by either obesity or ectopic fat deposition. Clin Sci2014; 126: 67–74.
10.
HughanKSTfayliHWarren-UlanchJG, et al.Early biomarkers of subclinical atherosclerosis in obese adolescent girls with polycystic ovary syndrome. J Pediatr2016; 168: 104–111.
11.
DuicaFDanilaCABobocAE, et al.Impact of increased oxidative stress on cardiovascular diseases in women with polycystic ovary syndrome. Front Endocrinol2021; 12: 614679.
12.
JabbourROttJEppelWFrigoP. Carotid intima-media thickness in polycystic ovary syndrome and its association with hormone and lipid profiles. PLoS One2020; 15: e0232299.
13.
TalbottEOZborowskiJRagerJStragandJR. Is there an independent effect of polycystic ovary syndrome (PCOS) and menopause on the prevalence of subclinical atherosclerosis in middle aged women?. Vasc Health Risk Manag2008; 4: 453–462.
14.
CelikCBastuEAbaliR, et al.The relationship between copper, homocysteine and early vascular disease in lean women with polycystic ovary syndrome. Gynecol Endocrinol2013; 29: 488–491.
15.
Bajuk StudenKŠebeštjenMPfeiferMPreželjJ. Influence of spironolactone treatment on endothelial function in non-obese women with polycystic ovary syndrome. Eur J Endocrinol2011; 164: 389–395.
16.
ArmeniEStamatelopoulosKRizosD, et al.Arterial stiffness is increased in asymptomatic nondiabetic postmenopausal women with a polycystic ovary syndrome phenotype. J Hypertens2013; 31: 1998–2004.
17.
TanBKChenJHuJ, et al.Metformin increases the novel adipokine cartonectin/CTRP3 in women with polycystic ovary syndrome. J Clin Endocrinol Metabol2013; 98: E1891–E1900.
18.
SoaresGMVieiraCSMartinsWP, et al.Increased arterial stiffness in nonobese women with polycystic ovary syndrome (PCOS) without comorbidities: one more characteristic inherent to the syndrome?. Clin Endocrinol2009; 71: 406–411.
19.
HartRHickeyMFranksS. Definitions, prevalence and symptoms of polycystic ovaries and polycystic ovary syndrome. Best Pract Res Clin Obstet Gynaecol2004; 18: 671–683.
20.
SirmansSPateK. Epidemiology, diagnosis, and management of polycystic ovary syndrome. Clin Epidemiol2013; 6: 1–13.
21.
BaiRZhangYLiuW, et al.The relationship of ankylosing spondylitis and subclinical atherosclerosis: a systemic review and meta-analysis. Angiology2019; 70: 492–500.
22.
GuzickDSTalbottEOSutton-TyrrellK, et al.Carotid atherosclerosis in women with polycystic ovary syndrome: initial results from a case-control study. Am J Obstet Gynecol1996; 174: 1224–1232, discussion 29-32.
23.
TalbottEOGuzickDSSutton-TyrrellK, et al.Evidence for association between polycystic ovary syndrome and premature carotid atherosclerosis in middle-aged women. Arterioscler Thromb Vasc Biol2000; 20: 2414–2421.
24.
KellyCJGSpeirsAGouldGW, et al.Altered vascular function in young women with polycystic ovary syndrome. J Clin Endocrinol Metabol2002; 87: 742–746.
25.
ChristianRCDumesicDABehrenbeckT, et al.Prevalence and predictors of coronary artery calcification in women with polycystic ovary syndrome. J Clin Endocrinol Metabol2003; 88: 2562–2568.
26.
SundararamanPGManomaniRSridharGR, et al.Risk of atherosclerosis in women with polycystic ovary syndrome: a study from south india. Metab Syndr Relat Disord2003; 1: 271–275.
27.
LakhaniKHardimanPSeifalianAM. Intima-media thickness of elastic and muscular arteries of young women with polycystic ovaries. Atherosclerosis2004; 175: 353–359.
28.
OrioFJr.PalombaSCascellaT, et al.Early impairment of endothelial structure and function in young normal-weight women with polycystic ovary syndrome. J Clin Endocrinol Metabol2004; 89: 4588–4593.
29.
TarkunİArslanBÇCantürkZ, et al.Endothelial dysfunction in young women with polycystic ovary syndrome: relationship with insulin resistance and low-grade chronic inflammation. J Clin Endocrinol Metabol2004; 89: 5592–5596.
30.
Diamanti-KandarakisEAlexandrakiKProtogerouA, et al.Metformin administration improves endothelial function in women with polycystic ovary syndrome. Eur J Endocrinol2005; 152: 749–756.
31.
KravaritiMNakaKKKalantaridouSN, et al.Predictors of endothelial dysfunction in young women with polycystic ovary syndrome. J Clin Endocrinol Metabol2005; 90: 5088–5095.
32.
MeyerCMcGrathBPTeedeHJ. Overweight women with polycystic ovary syndrome have evidence of subclinical cardiovascular disease. J Clin Endocrinol Metabol2005; 90: 5711–5716.
33.
VryonidouAPapatheodorouATavridouA, et al.Association of hyperandrogenemic and metabolic phenotype with carotid intima-media thickness in young women with polycystic ovary syndrome. J Clin Endocrinol Metabol2005; 90: 2740–2746.
34.
VuralBCaliskanETurkozEKilicTDemirciA. Evaluation of metabolic syndrome frequency and premature carotid atherosclerosis in young women with polycystic ovary syndrome. Hum Reprod2005; 20: 2409–2413.
35.
AlexandrakiKProtogerouAPapaioannouT, et al.Early microvascular and macrovascular dysfunction is not accompanied by structural arterial injury in polycystic ovary syndrome. Hormones (Basel)2006; 5: 126–136.
36.
BrinkworthGNoakesMMoranL, et al.Flow-mediated dilatation in overweight and obese women with polycystic ovary syndrome. BJOG An Int J Obstet Gynaecol2006; 113: 1308–1314.
37.
CarminaEOrioFPalombaS, et al.Endothelial dysfunction in PCOS: role of obesity and adipose hormones. Am J Med2006; 119: 356–6.
38.
Diamanti-KandarakisEAlexandrakiKPiperiC, et al.Inflammatory and endothelial markers in women with polycystic ovary syndrome. Eur J Clin Invest2006; 36: 691–697.
39.
SorensenMBFranksSRobertsonC, et al.Severe endothelial dysfunction in young women with polycystic ovary syndrome is only partially explained by known cardiovascular risk factors. Clin Endocrinol2006; 65: 655–659.
40.
BeckmanJAGoldfineABDunaifA, et al.Endothelial function varies according to insulin resistance disease type. Diabetes Care2007; 30: 1226–1232.
41.
Luque-RamirezMMendieta-AzconaCAlvarez-BlascoF, et al.Androgen excess is associated with the increased carotid intima-media thickness observed in young women with polycystic ovary syndrome. Hum Reprod2007; 22: 3197–3203.
42.
ShroffRKerchnerAMaifeldM, et al.Young obese women with polycystic ovary syndrome have evidence of early coronary atherosclerosis. J Clin Endocrinol Metabol2007; 92: 4609–4614.
43.
CascellaTPalombaSDe SioI, et al.Visceral fat is associated with cardiovascular risk in women with polycystic ovary syndrome. Hum Reprod (Oxf)2008; 23: 153–159.
44.
CostaLOBFSantosMPDOliveiraMVianaA. Low-grade chronic inflammation is not accompanied by structural arterial injury in polycystic ovary syndrome. Diabetes Research and Clinical Practice2008; 81: 179–183.
45.
HeutlingDSchulzHNickelI, et al.Asymmetrical dimethylarginine, inflammatory and metabolic parameters in women with polycystic ovary syndrome before and after metformin treatment. J Clin Endocrinol Metabol2008; 93: 82–90.
46.
KaradenizMErdoğanMTamselS, et al.Oxidative stress markers in young patients with polycystic ovary syndrome, the relationship between insulin resistances. Exp Clin Endocrinol Diabetes2008; 116: 231–235.
47.
SahaSSarkarCBiswasSCKarimR. Correlation between serum lipid profile and carotid intima-media thickness in polycystic ovarian syndrome. Indian J Clin Biochem2008; 23: 262–266.
48.
TrakakisEBalanikaABaltasC, et al.Hemodynamic alterations and wall properties in large arteries of young, normotensive, and non-obese women with polycystic ovary syndrome. J Endocrinol Invest2008; 31: 1001–1007.
49.
ArikanSAkayHBahceciM, et al.The evaluation of endothelial function with flow-mediated dilatation and carotid intima media thickness in young nonobese polycystic ovary syndrom patients; existence of insulin resistance alone may not represent an adequate condition for deterioration of endothelial function. Fertil Steril2009; 91: 450–455.
50.
CarminaEGuastellaELongoRA, et al.Correlates of increased lean muscle mass in women with polycystic ovary syndrome. Eur J Endocrinol2009; 161: 583–589.
51.
CicconeMMFavaleSBhuvaA, et al.Anteroposterior diameter of the infrarenal abdominal aorta is higher in women with polycystic ovary syndrome. Vasc Health Risk Manag2009; 5: 561–566.
52.
CussonsAJWattsGFStuckeyBGA. Dissociation of endothelial function and arterial stiffness in nonobese women with polycystic ovary syndrome (PCOS). Clin Endocrinol2009; 71: 808–814.
53.
ErdoganMKaradenizMBerdeliA, et al.The relationship of the interleukin-6 −174 G>C gene polymorphism with cardiovascular risk factors in Turkish polycystic ovary syndrome patients. Int J Immunogenet2009; 36: 283–288.
54.
AdaliEYildizhanRKurdogluM, et al.Increased plasma thrombin-activatable fibrinolysis inhibitor levels in young obese women with polycystic ovary syndrome. Fertil Steril2010; 94: 666–672.
55.
KetelIJStehouwerCDHenryRM, et al.Greater Arterial Stiffness in Polycystic Ovary Syndrome (PCOS) is an obesity- but not a PCOS-associated phenomenon. J Clin Endocrinol Metabol2010; 95: 4566–4575.
56.
PamukBOTorunANKulaksizogluM, et al.Asymmetric dimethylarginine levels and carotid intima-media thickness in obese patients with polycystic ovary syndrome and their relationship to metabolic parameters. Fertil Steril2010; 93: 1227–1233.
57.
BattagliaCBattagliaBManciniF, et al.Ultrasonographic extended-view technique for evaluation of abdominal fat distribution in lean women with polycystic ovary syndrome. Acta Obstet Gynecol Scand2011; 90: 600–608.
58.
CaglarGSOztasEKaradagD, et al.Ischemia-modified albumin and cardiovascular risk markers in polycystic ovary syndrome with or without insulin resistance. Fertil Steril2011; 95: 310–313.
59.
ChangAYAyersCMinhajuddinA, et al.Polycystic ovarian syndrome and subclinical atherosclerosis among women of reproductive age in the Dallas heart study. Clin Endocrinol2011; 74: 89–96.
60.
CoksuerHKoplayMOghanF, et al.Evaluation of carotid wall thickness and vertebro-basilar system insufficiency in patients with obese polycystic ovary syndrome. J Obstet Gynaecol Res2011; 37: 997–1003.
61.
DemirBPasaSDemirS, et al.Morphologic and functional vascular alterations in patients with polycystic ovary syndrome. Clin Exp Obstet Gynecol2011; 38: 401–404.
62.
ErcanEAErtekSIsG, et al.Factors associated with increased carotid intima-media thickness and being nondipper in nonobese and normotensive young patients affected by PCOS. Angiology2011; 62: 543–548.
63.
MohammadiAAghasiMJodeiry-FarshbafL, et al.Evaluation of early atherosclerotic findings in women with polycystic ovary syndrome. J Ovarian Res2011; 4: 19.
64.
MoranLJCameronJDStraussBJTeedeHJ. Vascular function in the diagnostic categories of polycystic ovary syndrome. Hum Reprod2011; 26: 2192–2199.
65.
NakaKKKalantaridouSNKravaritiM, et al.Effect of the insulin sensitizers metformin and pioglitazone on endothelial function in young women with polycystic ovary syndrome: a prospective randomized study. Fertil Steril2011; 95: 203–209.
66.
PepeneCEIlieIRMarianIDunceaI. Circulating osteoprotegerin and soluble receptor activator of nuclear factor κB ligand in polycystic ovary syndrome: relationships to insulin resistance and endothelial dysfunction. Eur J Endocrinol2011; 164: 61–68.
67.
SasakiAEmiYMatsudaM, et al.Increased arterial stiffness in mildly-hypertensive women with polycystic ovary syndrome. J Obstet Gynaecol Res2011; 37: 402–411.
68.
SoymanZNoyanVTulmacM, et al.Serum paraoxonase 1 activity, asymmetric dimethylarginine levels, and brachial artery flow-mediated dilatation in women with polycystic ovary syndrome. Fertil Steril2011; 95: 1067–1072.
69.
CakirEOzbekMSahinM, et al.Heart type fatty acid binding protein response and subsequent development of atherosclerosis in insulin resistant polycystic ovary syndrome patients. J Ovarian Res2012; 5: 45.
70.
KarabulutAYaylaliGFDemirlenkS, et al.Evaluation of body fat distribution in PCOS and its association with carotid atherosclerosis and insulin resistance. Gynecol Endocrinol2012; 28: 111–114.
71.
ZueffLFNMartinsWPVieiraCSFerrianiRA. Ultrasonographic and laboratory markers of metabolic and cardiovascular disease risk in obese women with polycystic ovary syndrome. Ultrasound Obstet Gynecol2012; 39: 341–347.
72.
AbaliRCelikCTasdemirN, et al.The serum protein α2-Heremans-Schmid glycoprotein/fetuin-a concentration and carotid intima-media thickness in women with polycystic ovary syndrome. Eur J Obstet Gynecol Reprod Biol2013; 169: 45–49.
73.
AllamehZRouholaminSAdibiA, et al.Does carotid intima-media thickness have relationship with polycystic ovary syndrome?Int J Prev Med2013; 4: 1266–1270.
74.
BarcellosCRGLageSHGRochaMP, et al.Polycystic ovary syndrome and obesity do not affect vascular parameters related to early atherosclerosis in young women without glucose metabolism disturbances, arterial hypertension and severe abnormalities of lipid profile. Gynecol Endocrinol2013; 29: 370–374.
75.
KahalHAburimaAUngvariT, et al.Polycystic ovary syndrome has no independent effect on vascular, inflammatory or thrombotic markers when matched for obesity. Clin Endocrinol2013; 79: 252–258.
76.
KimJJChoiYMKangJH, et al.Carotid intima-media thickness in mainly non-obese women with polycystic ovary syndrome and age-matched controls. Obstetrics & Gynecology Science2013; 56: 249–255.
77.
YildirICKutluturkFTasliyurtT, et al.Insulin resistance and cardiovascular risk factors in women with PCOS who have normal glucose tolerance test. Gynecol Endocrinol2013; 29: 148–151.
78.
BerberogluZAktasAFidanY, et al.Plasma GDF-15 levels and their association with hormonal and metabolic status in women with polycystic ovary syndrome aged 25-35. Minerva Endocrinologica2014; 39: 89–97.
79.
BuyukkayaRBesirFHYazganS, et al.The evaluation of carotid intima-media thickness and visceral obesity as an atherosclerosis predictor in newly-diagnosed polycystic ovary syndrome. La Clinica terapeutica2014; 165: e6–11.
80.
Calderon-MargalitRSiscovickDMerkinSS, et al.Prospective association of polycystic ovary syndrome with coronary artery calcification and carotid-intima-media thickness. Arterioscler Thromb Vasc Biol2014; 34: 2688–2694.
81.
GencerMGaziEHacıvelioğluS, et al.The relationship between subclinical cardiovascular disease and lipocalin-2 levels in women with PCOS. Eur J Obstet Gynecol Reprod Biol2014; 181: 99–103.
82.
GuleriaAKSyalSKKapoorA, et al.Cardiovascular disease risk in young indian women with polycystic ovary syndrome. Gynecol Endocrinol2014; 30: 26–29.
83.
KarbekBOzbekMKarakoseM, et al.Copeptin, a surrogate marker for arginine vasopressin, is associated with cardiovascular risk in patients with polycystic ovary syndrome. J Ovarian Res2014; 7: 31.
84.
PeiY-JWangA-MZhaoY, et al.Studies of cardiovascular risk factors in polycystic ovary syndrome patients combined with subclinical hypothyroidism. Gynecol Endocrinol2014; 30: 553–556.
85.
ReesECoulsonRDunstanF, et al.Central arterial stiffness and diastolic dysfunction are associated with insulin resistance and abdominal obesity in young women but polycystic ovary syndrome does not confer additional risk. Hum Reprod2014; 29: 2041–2049.
86.
ShokeirTEl-KannishyG. The effects of laparoscopic ovarian drilling on flow mediated dilation in women with PCOS: relationship with insulin resistance and IGF-I. Minerva Ginecologica2014; 66: 209–218.
87.
SnyderMLShieldsKJKorytkowskiMT, et al.Complement protein C3 and coronary artery calcium in middle-aged women with polycystic ovary syndrome and controls. Gynecol Endocrinol2014; 30: 511–515.
88.
AbaliRTasdemirNAlpsoyS, et al.No relationship between osteoprotegerin concentrations and endothelial dysfunction in non-obese women with and without polycystic ovary syndrome. Arch Gynecol Obstet2015; 291: 1075–1080.
89.
AldrighiJMTsutsuiJMKowastchI, et al.Effects of insulin resistance on myocardial blood flow and arterial peripheral circulation in patients with polycystic ovary syndrome. Echocardiography2015; 32: 1277–1284.
90.
DeveerMDeveerRBasaranO, et al.Serum copeptin, pentraxin 3, anti-mullerian hormone levels with echocardiography and carotid artery intima-media thickness in adolescents with polycystic ovary syndrome. J Clin Med Res2015; 7: 989–994.
91.
MacutDBačevićMBožić-AntićI, et al.Predictors of subclinical cardiovascular disease in women with polycystic ovary syndrome: interrelationship of dyslipidemia and arterial blood pressure. International journal of endocrinology2015; 2015: 812610.
92.
TaskinMIBulbulEAdaliE, et al.Circulating levels of obestatin and copeptin in obese and nonobese women with polycystic ovary syndrome. Eur J Obstet Gynecol Reprod Biol2015; 189: 19–23.
93.
GargNDharmalingamMPrabhuVMurthyNS. Carotid intimo-medial thickness: A predictor for cardiovascular disorder in patients with polycystic ovarian syndrome in the South Indian population. Indian journal of endocrinology and metabolism2016; 20: 662–666.
94.
Gursoy CalanOCalanMYesil SensesP, et al.Increased adipsin is associated with carotid intima media thickness and metabolic disturbances in polycystic ovary syndrome. Clin Endocrinol2016; 85: 910–917.
95.
BicerMGulerAUnal KocabasG, et al.Endocan is a predictor of increased cardiovascular risk in women with polycystic ovary syndrome. Endocr Res2017; 42: 145–153.
96.
DarghamSRAhmedLKilpatrickESAtkinSL. The prevalence and metabolic characteristics of polycystic ovary syndrome in the Qatari population. PLoS One2017; 12: e0181467.
97.
LebkowskaAAdamskaAJacewiczM, et al.Association between polycystic ovary syndrome and the risk of subclinical vascular disease in normalweight women with type 1 diabetes. Pol Arch Intern Med2017; 127: 741–748.
98.
PatelSSTruongUKingM, et al.Obese adolescents with polycystic ovarian syndrome have elevated cardiovascular disease risk markers. Vasc Med2017; 22: 85–95.
99.
RamogluSYoldemirTAtasayanKYavuzDG. Does cardiovascular risk vary according to the criteria for a diagnosis of polycystic ovary syndrome?. J Obstet Gynaecol Res2017; 43: 1848–1854.
100.
WangHLinMXiangG. Serum HMGB1 levels and its association with endothelial dysfunction in patients with polycystic ovary syndrome. Physiol Res2018; 67: 911–919.
101.
RashadNMEl-ShalASAbomandourHG, et al.Intercellular adhesion molecule-1 expression and serum levels as markers of pre-clinical atherosclerosis in polycystic ovary syndrome. J Ovarian Res2019; 12: 97.
102.
AtasayanKYoldemirT. The effect of PCOS status on atherosclerosis markers and cardiovascular disease risk factors in young women with vitamin D deficiency. Gynecol Endocrinol2021; 37: 225–229.
103.
KrentowskaALebkowskaAJacewicz-SwieckaM, et al.Metabolic syndrome and the risk of cardiovascular complications in young patients with different phenotypes of polycystic ovary syndrome. Endocrine2021; 72: 400–410.
104.
Yalcin BahatPÖzelADemirciA. Evaluation of carotid artery intima-media thickness as a cardiovascular risk factor in patients with polycystic ovary syndrome. Cureus2021; 13: e13025.
105.
JavedaniMAerab-SheibaniHMadadiYYoonesiL. Relationship between C-reactive protein and carotid artery intima media thickness in polycystic ovarian syndrome patients. Acta Med Mediterr2015; 31: 1393–1398.
106.
AydınGATuran ÖzsoyHG. The relationship of osteoprotegerin with cardiovascular risk factors in women with and without polycystic ovary syndrome. Haseki Tip Bulteni2020; 58: 274–280.
107.
RibeiroALScapinelliAKowatschI, et al.Effects of insulin resistance on myocardial blood flow and arterial peripheral circulation in patients with polycystic ovary syndrome. Ultrasound Med Biol2013; 39: S83–S84.
108.
IlieIPepeneCMarianI, et al.The polycystic ovary syndrome (pcos) status and cardiovascular risk in young women. Open Med2011; 6: 64–75.
109.
MeyerMLMalekAMWildRA, et al.Carotid artery intima-media thickness in polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update2012; 18: 112–126.
110.
SprungVSAtkinsonGCuthbertsonDJ, et al.Endothelial function measured using flow-mediated dilation in polycystic ovary syndrome: a meta-analysis of the observational studies. Clin Endocrinol2013; 78: 438–446.
111.
MassziGHorvathEMTarszaboR, et al.Reduced estradiol-induced vasodilation and poly-(ADP-ribose) polymerase (PARP) activity in the aortas of rats with experimental polycystic ovary syndrome (PCOS). PLoS One2013; 8: e55589.
112.
RegidorPAMuellerASailerM, et al.Chronic inflammation in PCOS: the potential benefits of specialized pro-resolving lipid mediators (SPMs) in the improvement of the resolutive response. Int J Mol Sci2020; 22: 22.
113.
HuangGCovielloA. Clinical update on screening, diagnosis and management of metabolic disorders and cardiovascular risk factors associated with polycystic ovary syndrome. Curr Opin Endocrinol Diabetes Obes2012; 19: 512–519.
114.
MengXLiXXuX, et al.Elevated luteinizing hormone contributes to atherosclerosis formation by inhibiting nitric oxide synthesis via PI3K/Akt pathway. Vasc Pharmacol2019; 121: 106582.
115.
SimaAVStancuCSSimionescuM. Vascular endothelium in atherosclerosis. Cell Tissue Res2009; 335: 191–203.
116.
BruckBBrehmeUGugelN, et al.Gender-specific differences in the effects of testosterone and estrogen on the development of atherosclerosis in rabbits. Arterioscler Thromb Vasc Biol1997; 17: 2192–2199.
117.
AdamsMRWilliamsJKKaplanJR. Effects of androgens on coronary artery atherosclerosis and atherosclerosis-related impairment of vascular responsiveness. Arterioscler Thromb Vasc Biol1995; 15: 562–570.
118.
Rask-MadsenCLiQFreundB, et al.Loss of insulin signaling in vascular endothelial cells accelerates atherosclerosis in apolipoprotein E null mice. Cell Metabolism2010; 11: 379–389.
119.
Escobar-MorrealeHFLuque-RamírezMGonzálezF. Circulating inflammatory markers in polycystic ovary syndrome: a systematic review and metaanalysis. Fertil Steril2011; 95: 1048–1058.
120.
BadimonLPeñaEArderiuG, et al.C-Reactive protein in atherothrombosis and angiogenesis. Front Immunol2018; 9: 430.
121.
TedguiAMallatZ. Cytokines in atherosclerosis: pathogenic and regulatory pathways. Physiol Rev2006; 86: 515–581.
122.
FishmanSLSonmezHBasmanC, et al.The role of advanced glycation end-products in the development of coronary artery disease in patients with and without diabetes mellitus: a review. Mol Med2018; 24: 59.
123.
RudnickaESuchtaKGrymowiczM, et al.Chronic Low Grade Inflammation in Pathogenesis of PCOS. Int J Mol Sci2021; 22: 3789.
124.
ZuoTZhuMXuW. Roles of oxidative stress in polycystic ovary syndrome and cancers. Oxid Med cell Longev, 2016; 2016: 8589318.
125.
RojasJChávezMOlivarL, et al.Polycystic ovary syndrome, insulin resistance, and obesity: navigating the pathophysiologic labyrinth. Int J Repro Med2014; 2014: 719050.
LorenzMWMarkusHSBotsML, et al.Prediction of clinical cardiovascular events with carotid intima-media thickness. Circulation2007; 115: 459–467.
128.
AkamatsuDSatoAGotoH, et al.Nitroglycerin-mediated vasodilatation of the brachial artery may predict long-term cardiovascular events irrespective of the presence of atherosclerotic disease. J Atherosclerosis Thromb2010; 17: 1266–1274.
129.
RasRTStreppelMTDraijerRZockPL. Flow-mediated dilation and cardiovascular risk prediction: a systematic review with meta-analysis. Int J Cardiol2013; 168: 344–351.
130.
ZhongQHuM-JCuiY-J, et al.Carotid-femoral pulse wave velocity in the prediction of cardiovascular events and mortality: an updated systematic review and meta-analysis. Angiology2018; 69: 617–629.
131.
AdelhoeferSUddinSMIOseiAD, et al.Coronary artery calcium scoring: new insights into clinical interpretation-lessons from the Cac consortium. Radiology: Cardiothoracic Imaging2020; 2: e200281.
132.
BaldaniDPSkrgaticLOugouagR. Polycystic ovary syndrome: important underrecognised cardiometabolic risk factor in reproductive-age women. Int J Endocrinology2015; 2015: 786362.
133.
FernandesJBSoaresGMMartinsWP, et al.[Obesity and altered arterial structure in young women with micropolycystic ovary syndrome]. Rev Bras Ginecol Obstet2009; 31: 342–348.
134.
AiR. [Peculiarities of functional state of endothelium in women with polycystic ovaries]. Kardiologiia2008; 48: 57–61.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
