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Carotid artery intima-media thickness in polycystic ovary syndrome: a systematic review and meta-analysis
Open accessAbstract
BACKGROUND: Polycystic ovary syndrome (PCOS) is a common reproductive endocrine disorder associated with cardiovascular disease (CVD) risk factors and metabolic disturbances. This systematic review and meta-analysis was conducted to determine whether carotid intima-media thickness (CIMT), a marker of subclinical atherosclerosis, is higher in women with PCOS compared with women without PCOS. METHODS: Primary articles reporting the mean CIMT in women with PCOS and controls were identified using Ovid MEDLINE, EMBASE and PUBMED. We performed a random-effects meta-analysis and created forest plots of the mean difference in CIMT and conducted tests for heterogeneity and publication bias. Studies were grouped by quality, defined by reporting reproducibility of CIMT and averaging both common carotid arteries versus one side for CIMT. RESULTS: From the 36 eligible full-text studies, 8 studies were included in the systematic review and 19 studies were included in the meta-analysis (total n= 1123 women with PCOS, n= 923 controls). The summary mean difference in CIMT among women with PCOS compared with controls was 0.072 mm [95% confidence interval (CI) 0.040, 0.105, P < 0.0001] for highest quality studies, 0.084 mm (95% CI 0.042, 0.126, P = 0.0001) for good quality studies, 0.041 (95% CI -0.038, 0.120, P = 0.310) for fair-quality studies and 0.045 (95% CI -0.020, 0.111, P = 0.173) for lower quality studies. CONCLUSIONS: Larger studies with a well-defined PCOS population using rigorous methodology may be required to draw a more robust conclusion. However, these results suggest women with PCOS are at a greater risk of premature atherosclerosis, which emphasizes the importance of screening and monitoring CVD risk factors in women with PCOS.
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“Young women and adolescents with PCOS have been shown to have early atherosclerotic CVD, including increased carotid intimal medial thickness and carotid plaque.86, 87, 88, 89”
From Increased Prevalence of Adverse Health Outcomes Across the Lifespan in Those Affected by Polycystic Ovary Syndrome: A Canadian Population Cohort (2024) · cites this paper as [86]
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“The summary estimate of the mean difference in CIMT among women with PCOS compared with controls was 0.072 mm (95% CI 0.040 – 0.105, p 0.0001) for highest-quality studies and 0.084 mm (95% CI 0.042 – 0.126, p ¼ 0.0001) for good-quality studies, with higher CIMTs for women with PCOS 25 .”
InfluentialThe cardiovascular risk profile of middle‐aged women with polycystic ovary syndrome
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Gonadal hormones and stroke risk: PCOS as a case study
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Targets to treat androgen excess in polycystic ovary syndrome
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“Women with PCOS have a higher prevalence of weight excess and central obesity [19], gestational diabetes [4], glucose intolerance, type 2 diabetes mellitus, and metabolic syndrome [4,20], dyslipidemia [21], hypertension [22], subclinical atherosclerosis [23,24], endothelial dysfunction [25], chronic subclinical inflam…”
BackgroundTalari, H. R., Azad, Z. J., Hamidian, Y., Samimi, M., Gilasi, H. R., Afshar, F. E., Ostadmohammadi, V., & Asemi, Z. (2019) · International Journal of Preventive Medicine · doi:10.4103/ijpvm.ijpvm_2_18 · Cited by 18
Vine, D. F., Beilin, L. J., Burrows, S., Huang, R.-C., Hickey, M., Hart, R., Proctor, S. D., & Mori, T. A. (2020) · Journal of the Endocrine Society · doi:10.1210/jendso/bvaa061 · Cited by 17
“Women with PCOS are reported to have increased incidence of type-2 diabetes and premature cardiovascular disease (CVD) [1-4].”
BackgroundKim, J., Choi, Y. M., Kang, J. H., Hwang, K. R., Chae, S. J., Kim, S. M., Ku, S., Kim, S. H., Kim, J. G., & Moon, S. Y. (2013) · Obstetrics & Gynecology Science · doi:10.5468/ogs.2013.56.4.249 · Cited by 17
“Recently, systematic review and meta-analysis has been reported [18].”
BackgroundBarcellos, C. R. G., Rocha, M. P., Hayashida, S. A. Y., Dantas, W. S., Yance, V. D. R. V., & Marcondes, J. A. M. (2015) · HORMONES · doi:10.14310/horm.2002.1584 · Cited by 17
Mažibrada, I., Djukic, T. I., Perović, S., Pljesa-Ercegovac, M. S., Plavšić, L., Bojanin, D., Bjekić-Macut, J., Simić, P. D., Simic, T. P., Savic-Radojevic, A. R., et al. (2018) · Journal of Pediatric Endocrinology and Metabolism · doi:10.1515/jpem-2017-0511 · Cited by 17
Garoufi, A., Pagoni, A., Papadaki, M., Marmarinos, A., Karapostolakis, G., Michala, L., & Soldatou, A. (2021) · Children · doi:10.3390/children9010004 · Cited by 18
“Some studies have demonstrated higher cIMT values in those with PCOS compared to age- and/or BMI-matched non-PCOS controls, whereas others have shown no difference between PCOS women and controls, independently of obesity, and between obese and normal-weight women independently of PCOS [19,20,24,43,44].”
BackgroundResultMidlife women’s health consequences associated with polycystic ovary syndrome
Ali, A. T., & Guidozzi, F. (2019) · Climacteric · doi:10.1080/13697137.2019.1679111 · Cited by 16
Kılıç, D., Kılıç, İ. D., Sevgican, C. İ., Kilic, O., Alataş, E., Arslan, M., Avcı, E., & Güler, T. (2020) · Journal of obstetrics and gynaecology research · doi:10.1111/jog.14543 · Cited by 15
Pazderska, A., Tun, T. K., Phelan, N., McGowan, A., Sherlock, M., Behan, L., Boran, G. P., & Gibney, J. (2017) · Clinical Endocrinology · doi:10.1111/cen.13542 · Cited by 17
“Number 103 102 80 80 Age (y)a 28 (8) 32 (10) <.”
Cardiovascular Risk in Postmenopausal Women with Polycystic Ovary Syndrome
Armeni, E., & Lambrinoudaki, I. V. (2018) · Current Vascular Pharmacology · doi:10.2174/1570161116666180828154006 · Cited by 15
Mahboobifard, F., Rahmati, M., Niknam, A., Rojhani, E., Momenan, A. A., Azizi, F., & Tehrani, F. R. (2021) · Archives of Medical Research · doi:10.1016/j.arcmed.2021.11.001 · Cited by 14
Biomediators in Polycystic Ovary Syndrome and Cardiovascular Risk
Pandurevic, S., Μacut, D., Fanelli, F., Pagotto, U., & Gambineri, A. (2021) · Biomolecules · doi:10.3390/biom11091350 · Cited by 14
Joham, A. E., Rees, A., Shinkai, K., Forslund, M., Tay, C. T., & Teede, H. J. (2025) · Reproduction · doi:10.1530/rep-25-0121 · Cited by 13
Female-specific risk factors for cardiovascular disease: an update
Theodorou, A., Karagiannakis, D. S., Stefanaki, K., Kassi, E., Peppa, Μ., Vryonidou, A., & Paschou, S. Α. (2024) · HORMONES · doi:10.1007/s42000-024-00576-5 · Cited by 13
“Women with hyper-androgenism exhibit a higher progression ratio of coronary artery calcium (CAC) [65], an increased thickness of the carotid intimal medial and carotid plaque [66], and lower flow-mediated brachial artery dilation [67].”
Polycystic ovary syndrome and metabolic syndrome: the worrisome twosome?
Shah, D., & Rasool, S. (2015) · Climacteric · doi:10.3109/13697137.2015.1116505 · Cited by 13
van der Ham, K., Koster, M. P. H., Velthuis, B. K., Budde, R. P. J., Fauser, B. C. J. M., Laven, J. S. E., & Louwers, Y. V. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12165226 · Cited by 12
“Some studies also described an increased risk for subclinical atherosclerosis and endothelial dysfunction in young women with PCOS compared to controls, reflected in increased carotid intima-media thickness (CIMT) and Coronary Artery Calcification Scores (CACs) [6,7].”
BackgroundAssociation of serum androgens and coronary artery calcium scores in women
Penn, C. A., Chan, J. L., Mesaros, C., Snyder, N. W., Rader, D. J., Sammel, M. D., & Dokras, A. (2019) · Fertility and Sterility · doi:10.1016/j.fertnstert.2019.04.024 · Cited by 12
“Also, young premenopausal women with PCOS have reduced flow-mediated dilatation independent of BMI (35) and increased prevalence of high CIMT compared to controls (36).”
BackgroundXue-lan, L., Yang, J., Blockeel, C., Lin, M., Tian, X., Wu, H., Cao, Y., Deng, L., Zhou, X., Xie, J., et al. (2024) · Acta Obstetricia Et Gynecologica Scandinavica · doi:10.1111/aogs.14863 · Cited by 10
“8,9 These findings emphasize the importance of assessing “cardiometabolic risk” in women with PCOS in clinical practice.”
BackgroundGambineri, A., Rosa, S., Pandurevic, S., Cecchetti, C., Rotolo, L., Dionese, P., Belardinelli, E., Solmi, B., Zavatta, G., Fanelli, F., et al. (2025) · European Journal of Endocrinology · doi:10.1093/ejendo/lvaf027 · Cited by 11
Pandurevic, S., Bergamaschi, L., Pizzi, C., Patton, L., Rucci, P., Corzani, F., Cecchetti, C., Pelusi, C., Altieri, P., Vicennati, V., et al. (2020) · European Journal of Endocrinology · doi:10.1530/eje-20-0725 · Cited by 11
Nejabati, H. R., Samadi, N., Roshangar, L., & Nouri, M. (2019) · Life Sciences · doi:10.1016/j.lfs.2019.116843 · Cited by 11
Godtfredsen, A. C., Sidelmann, J. J., Gram, J., Andersen, M., & Glintborg, D. (2020) · Acta Obstetricia Et Gynecologica Scandinavica · doi:10.1111/aogs.13825 · Cited by 11
Wu, Y., Yang, X., Hu, Y., Hu, X., Zhang, Y., An, T., Lv, B., Tao, S., Liu, Q. F., & Jiang, G. (2023) · Food Science & Nutrition · doi:10.1002/fsn3.3473 · Cited by 9
Aspects of Cardiometabolic Risk in Women with Polycystic Ovary Syndrome
Paterakis, T., & Diamanti‐Kandarakis, E. (2014) · Current Obesity Reports · doi:10.1007/s13679-014-0127-6 · Cited by 10
Abalı, R., Taşdemir, N., Alpsoy, Ş., Tasdemir, U. G., Güzel, S., Yüksel, M. A., Yüksel, İ. T., & Yılmaz, M. (2014) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-014-3499-7 · Cited by 10
“072 mm for women with PCOS for the high-quality studies, similar to our finding [26].”
Resultda Silva, A. V., de Melo, A. S., Barboza, R. P., Martins, W. P., Ferriani, R. A., & Vieira, C. S. (2016) · Reproductive Sciences · doi:10.1177/1933719115623648 · Cited by 10
Wu, X., Wilke, M., Batara, J., Proctor, S. D., Cree‐Green, M., Ghosh, M., Raggi, P., Windram, J. D., Becher, H. H., & Vine, D. F. (2025) · Frontiers in Endocrinology · doi:10.3389/fendo.2025.1520922 · Cited by 10
Woodward, A., Klonizakis, M., Lahart, I. M., Carter, A., Dalton, C., Metwally, M., & Broom, D. R. (2019) · Systematic Reviews · doi:10.1186/s13643-019-1030-8 · Cited by 9
Nandi, A., Singh, K. D., & Sharma, K. (2025) · Microchimica Acta · doi:10.1007/s00604-025-07187-w · Cited by 9
“…load consists of cardiovascular diseases (dyslipidemia [7], hypertension [8], myocardial infarction, stroke [9], carotid intima-media thickness [10]), metabolic risk (obesity [11], insulin resistance [12], nonalcoholic fatty liver disease [13], obstructive sleep apnea [14]), endometrial cancer…”
Adams, Z. H., Berbrier, D. E., Schwende, B. K., Huckins, W., Richards, C. T., Rees, A., Usselman, C. W., & Lord, R. N. (2025) · The Journal of Physiology · doi:10.1113/jp287288 · Cited by 9
Dharmalingam, M., Garg, N., Prabhu, V. M. D., & Murthy, N. S. (2016) · Indian Journal of Endocrinology and Metabolism · doi:10.4103/2230-8210.190552 · Cited by 8
“Materials and Methods: The cross‑sectional case‑control study was conducted in a tertiary care Hospital in South India.”
BackgroundResultInfluentialCardiovascular health and menopause in aging women with polycystic ovary syndrome
Helvacı, N., & Yıldız, B. O. (2020) · Expert Review of Endocrinology & Metabolism · doi:10.1080/17446651.2020.1719067 · Cited by 8
“Moreover, surrogate markers of early subclinical arterial disease such as increased carotid intima media thickness [29] and coronary artery calcification [30] or”
Background
Metadata
- Authors
- Meyer, M. L., Malek, A. M., Wild, R. A., Korytkowski, M. T., & Talbott, E. O.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- University of Pittsburgh (US)
- OU Health (US)
- University of Pittsburgh Medical Center (US)
- Corresponding author
- Meyer, Michelle L.
- Venue
- Human Reproduction Update
- Publisher
- Oxford University Press (OUP)
- Published
- 2011-11-22
- Volume
- 18
- Issue
- 2
- Pages
- 112-126
- ISSN
- 1355-4786 (ISSN-L)
- 1460-2369
- PMC
- PMC3383099
- OpenAlex
- W2165694459
- Cited by
- 175
- References
- 79
- Citations by year
- 2026: 12 · 2025: 9 · 2024: 12 · 2023: 10 · 2022: 10 · 2021: 17 · 2020: 12 · 2019: 18 · 2018: 12 · 2017: 9 · 2016: 7 · 2015: 22 · 2014: 16 · 2013: 7 · 2012: 1
- FWCI
- 1.24
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Human Reproduction Update (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Heart, Lung, and Blood Institute (T32 5T32HL007055-35, T32HL083825, T32HL007055)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Keywords
- polycystic ovary syndrome, carotid intima-media thickness, subclinical atherosclerosis, cardiovascular risk, premature atherosclerosis, women's cardiovascular health, study quality heterogeneity
- MeSH terms
- Female, Humans, Polycystic Ovary Syndrome, Risk Factors, Atherosclerosis, Carotid Intima-Media Thickness
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