Context: Polycystic ovary syndrome (PCOS) is associated with comorbidities that may contribute to increased risk of cardiovascular disease (CVD). PCOS is associated with increased risk of metabolic syndrome, dyslipidemia and diabetes, but it remains unclear if traditional cardiovascular (CV) risk factors can help predict coronary artery disease (CAD) in this population.

Objective: (a) To detect early-onset subclinical coronary atherosclerosis (using coronary artery calcium as a marker) in young women with PCOS compared to age- and BMI-matched controls. (b) To compare traditional CV risk factors and inflammatory markers in the two groups.

Design: Prospective case-control study.

Setting: University hospital.

Subjects: 24 obese (BMI 30) PCOS subjects and 24 obese controls.

Outcome Measures: Coronary artery calcium (CAC), inflammatory markers (hsCRP, IL-6, TNF, adiponectin, leptin), fasting blood tests (glucose, lipids, insulin) and DEXA scan for body fat distribution.

Results: CAC was detected in 8/24 (33%) PCOS subjects and 2/24 (8%) controls (OR 5.5, 95% CI: 1.03, 29.45, P<0.03). Traditional CV risk factors did not differ significantly between the two groups; nor did markers of inflammation or adiposity, body fat distribution or metabolic parameters with the exception of significantly lower QUICKI (marker for insulin resistance) in the PCOS group (p<0.05).

Conclusions: Young, obese women with PCOS have a high prevalence of early asymptomatic coronary atherosclerosis compared to obese controls. This increased risk is independent of traditional CV risk factors and novel markers of inflammation. These findings underscore the need to screen and aggressively counsel and treat these women to prevent symptomatic CVD.