IJCS | Volume 32, Nº1, January/ February 2019

8 1. Okoroh EM, HooperWC, AtrashHK, Yusuf HR, Boulet SL. Prevalence of polycystic ovary syndrome among the privately insured, United States, 2003-2008. Am J Obstet Gynecol. 2012;207(4):299.e1–7. 2. Moran LJ, Misso ML, Wild RA, Norman RJ. Impaired glucose tolerance, type 2 diabetes and metabolic syndrome in polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update. 2010;16(4):347–63. 3. Romano LGM, Bedoschi G, Melo AS, Albuquerque FO de, Rosa e Silva ACJ de S, Ferriani RA, et al. [Metabolic abnormalities in polycystic ovary syndrome women: obese and non obese]. Rev Bras Ginecol Obstet. 2011;33(6):310–6. 4. Ramezani Tehrani F, Montazeri SA, Hosseinpanah F, Cheraghi L, Erfani H, Tohidi M, et al. Trend of Cardio-Metabolic Risk Factors in Polycystic Ovary Syndrome: A Population-Based Prospective Cohort Study. PLoS One. 2015;10(9):e0137609. 5. Mani H, LevyMJ, DaviesMJ, Morris DH, Gray LJ, Bankart J, et al. Diabetes and cardiovascular events inwomenwithpolycystic ovary syndrome: a 20- year retrospective cohort study. Clin Endocrinol (Oxf). 2013;78(6):926–34. References Burlá et al. Vascular changes in polycystic ovarian syndrome Int J Cardiovasc Sci. 2019;32(1)3-9 Original Article women. In a young and non-obese sample of PCOS subjects, PWV and AIx were similar to healthy controls. 18 A recent study of 84 women with PCOS and 95 healthy volunteers, aged 16-45 years, also reported similar PWV between groups. 15 However, a small study showed that PCOS non-obese women had higher AIx than healthy controls, although not measuring PWV. 33 Our study showed that PWV and AIx were similar between PCOS subjects and controls. On the other hand, those PCOS women with higher testosterone levels had higher AIx, indicating greater reflected pulse wave, which might represent an initial process of arterial stiffness. As PWV is largely influenced by age, young patients, including those with PCOS, tend to have normal values. AIx may be a better parameter in this population, as it reflects the influence, at the aortic level, of an increased stiffness of the arterial tree. 30 This study has some limitations. First, sample size was small, so that we could have missed a small difference between PWV in PCOS and control groups. Second, as a cross-sectional study, we couldnot evaluate the occurrence of CV events, but merely suggest an association between FMD, AIx and PCOS. An important consideration of the study was to hypothesize a relationship between hyperandrogenismandan increasedpulsewave reflection, maybe associated with arterial stiffness. Conclusion In summary, these PCOS women demonstrated endothelial dysfunction when compared to those young overweight women without the syndrome. Moreover, higher testosterone levels, even in the normal range, were associated with an increase in pulse wave reflection. Large prospective studies are needed to evaluate the prognostic value of FMD, PWV and AIx in this population. In addition, large trials can analyze if measurement of endothelial function and arterial stiffness would improve CV risk stratification beyond traditional atherosclerotic risk factors. Author contributions Conception and design of the research: Burlá M, Oigman W, Neves MF, Medeiros F. Acquisition of data: Burlá M. Analysis and interpretation of the data: Burlá M, Cunha AR, Gismondi R, Oigman W, Neves MF, Medeiros F. Statistical analysis: Cunha AR, Gismondi R, Neves MF. Obtaining financing: Neves MF. Writing of the manuscript: Burlá M, Cunha AR, Gismondi R, Oigman W, Neves MF, Medeiros F. Critical revision of the manuscript for intellectual content: Burlá M, Cunha AR, Gismondi R, Oigman W, Neves MF, Medeiros F. Potential conflict of interest No potential conflict of interest relevant to this article was reported. Sources of funding There was no external funding for this study. Study association This article is part of the thesis submitted by Marcelo Burlá for fulfilment of the requirements for Master’s degree, University Hospital of Pedro Ernesto, Rio de Janeiro, Brazil. Ethics approval and consent to participate This study was approved by the Ethics Committee of the Hospital Universitário Pedro Ernesto under the protocol number 2795. All the procedures in this study were in accordance with the 1975 Helsinki Declaration, updated in 2013. Informed consent was obtained from all participants included in the study.