{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T16:23:23Z","timestamp":1792167803585,"version":"4.4.0"},"reference-count":121,"publisher":"The Endocrine Society","issue":"5","license":[{"start":{"date-parts":[[2023,10,27]],"date-time":"2023-10-27T00:00:00Z","timestamp":1698364800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004359","name":"The Swedish Research Council","doi-asserted-by":"publisher","award":["2021-01348"],"award-info":[{"award-number":["2021-01348"]}],"id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,4,19]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Hyperandrogenism in women, such as polycystic ovary syndrome, ovarian hyperthecosis, congenital adrenal hyperplasia, and androgen-secreting tumors, are all associated with increased prevalence of cardiovascular risk factors that include type 2 diabetes, hypertension, dyslipidemia, and metabolic syndrome. However, it is not clear whether this also implies enhanced risk of cardiovascular disease and mortality. Furthermore, the involvement of obesity and menopausal status for cardiometabolic risk in these women has not been elucidated. Based on the most recent systematic reviews and meta-analyses, this review summarizes the latest scientific evidence. To conclude, hyperandrogenism in premenopausal women is associated with enhanced prevalence of cardiovascular risk factors, as well as increased risk of cardiovascular disease and mortality, independently of body mass index. In contrast, elevated cardiovascular risk factors and increased risk of myocardial infarction and stroke in hyperandrogenic postmenopausal women are dependent on obesity. Furthermore, the overall risk of cardiovascular disease and coronary artery disease in hyperandrogenic postmenopausal women is similar to controls. The reason for a reduced cardiometabolic risk after menopause in hyperandrogenic women compared to nonhyperandrogenic women is not clear. It can be speculated that the difference in endocrine balance and metabolic status between women with and without hyperandrogenism might decrease after menopause because hyperandrogenism usually improves with age, whereas menopausal transition itself is associated with androgen dominance and abdominal obesity. Although we have gained increased knowledge about cardiometabolic risks in women with hyperandrogenism, it must be acknowledged that the quality of data is overall low. More research is needed, especially longer and larger follow-up studies in women with hyperandrogenism of different etiologies and phenotypes.<\/jats:p>","DOI":"10.1210\/clinem\/dgad590","type":"journal-article","created":{"date-parts":[[2023,10,27]],"date-time":"2023-10-27T09:40:33Z","timestamp":1698399633000},"page":"1202-1213","source":"Crossref","is-referenced-by-count":39,"title":["Hyperandrogenism and Cardiometabolic Risk in Pre- and Postmenopausal Women\u2014What Is the Evidence?"],"prefix":"10.1210","volume":"109","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6481-6277","authenticated-orcid":false,"given":"Angelica Lind\u00e9n","family":"Hirschberg","sequence":"first","affiliation":[{"name":"Department of Women's and Children's Health, Karolinska Institutet and Department of Gynecology and Reproductive Medicine, Karolinska University Hospital , SE-171 76 Stockholm , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2023,10,27]]},"reference":[{"issue":"5","key":"2024041923065648200_dgad590-B1","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.1210\/clinem\/dgac673","article-title":"Approach to investigation of hyperandrogenism in a postmenopausal woman","volume":"108","author":"Hirschberg","year":"2023","journal-title":"J Clin Endocrinol Metab"},{"issue":"6","key":"2024041923065648200_dgad590-B2","doi-asserted-by":"crossref","first-page":"1147","DOI":"10.1093\/humrep\/dex078","article-title":"Mass spectrometry, immunoassay and valid steroid measurements in reproductive medicine and science","volume":"32","author":"Handelsman","year":"2017","journal-title":"Hum Reprod"},{"issue":"10","key":"2024041923065648200_dgad590-B3","doi-asserted-by":"crossref","first-page":"2447","DOI":"10.1210\/clinem\/dgad463","article-title":"Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome","volume":"108","author":"Teede","year":"2023","journal-title":"J Clin Endocrinol Metab"},{"issue":"1","key":"2024041923065648200_dgad590-B4","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1093\/humrep\/deh098","article-title":"Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS)","volume":"19","author":"Rotterdam ESHRE\/ASRM-Sponsored PCOS consensus workshop group","year":"2004","journal-title":"Hum Reprod"},{"issue":"9","key":"2024041923065648200_dgad590-B5","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1016\/S2213-8587(22)00163-2","article-title":"Polycystic ovary syndrome","volume":"10","author":"Joham","year":"2022","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"12","key":"2024041923065648200_dgad590-B6","doi-asserted-by":"crossref","first-page":"2841","DOI":"10.1093\/humrep\/dew218","article-title":"The prevalence and phenotypic features of polycystic ovary syndrome: a systematic review and meta-analysis","volume":"31","author":"Bozdag","year":"2016","journal-title":"Hum Reprod"},{"issue":"12","key":"2024041923065648200_dgad590-B7","doi-asserted-by":"crossref","first-page":"4565","DOI":"10.1210\/jc.2013-2350","article-title":"Diagnosis and treatment of polycystic ovary syndrome: an endocrine society clinical practice guideline","volume":"98","author":"Legro","year":"2013","journal-title":"J Clin Endocrinol Metab"},{"issue":"2","key":"2024041923065648200_dgad590-B8","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1210\/clinem\/dgaa840","article-title":"Reproductive hormones and anthropometry: A follow-up of PCOS and controls from perimenopause to older than 80 years","volume":"106","author":"Forslund","year":"2021","journal-title":"J Clin Endocrinol Metab"},{"key":"2024041923065648200_dgad590-B9","doi-asserted-by":"publisher","DOI":"10.1093\/humupd\/dmad015","article-title":"PCOS During the menopausal transition and after menopause: a systematic review and meta-analysis","author":"Mill\u00e1n-de-Meer","journal-title":"Hum Reprod Update"},{"issue":"8","key":"2024041923065648200_dgad590-B10","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1080\/09513590.2021.1903419","article-title":"Hyperthecosis: an underestimated nontumorous cause of hyperandrogenism","volume":"37","author":"Meczekalski","year":"2021","journal-title":"Gynecol Endocrinol"},{"issue":"10108","key":"2024041923065648200_dgad590-B11","doi-asserted-by":"crossref","first-page":"2194","DOI":"10.1016\/S0140-6736(17)31431-9","article-title":"Congenital adrenal hyperplasia","volume":"390","author":"El-Maouche","year":"2017","journal-title":"Lancet"},{"issue":"5","key":"2024041923065648200_dgad590-B12","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1093\/humupd\/dmx014","article-title":"Non-classic congenital adrenal hyperplasia due to 21-hydroxylase deficiency revisited: an update with a special focus on adolescent and adult women","volume":"23","author":"Carmina","year":"2017","journal-title":"Hum Reprod Update"},{"issue":"11","key":"2024041923065648200_dgad590-B13","doi-asserted-by":"crossref","first-page":"4043","DOI":"10.1210\/jc.2018-01865","article-title":"Congenital adrenal hyperplasia due to steroid 21-hydroxylase deficiency: an endocrine society clinical practice guideline","volume":"103","author":"Speiser","year":"2018","journal-title":"J Clin Endocrinol Metab"},{"issue":"6","key":"2024041923065648200_dgad590-B14","doi-asserted-by":"crossref","first-page":"1192","DOI":"10.1016\/j.surg.2004.06.046","article-title":"Profile and outcome of pure androgen-secreting adrenal tumors in women: experience of 21 cases","volume":"136","author":"Moreno","year":"2004","journal-title":"Surgery"},{"key":"2024041923065648200_dgad590-B15","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1159\/000494906","article-title":"Androgen-Secreting ovarian tumors","volume":"53","author":"Macut","year":"2019","journal-title":"Front Horm Res"},{"issue":"1","key":"2024041923065648200_dgad590-B16","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/S0022-5347(05)64023-2","article-title":"Adrenocortical carcinoma: diagnosis, evaluation and treatment","volume":"169","author":"Ng","year":"2003","journal-title":"J Urol"},{"issue":"6","key":"2024041923065648200_dgad590-B17","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1210\/er.2011-1034","article-title":"Insulin resistance and the polycystic ovary syndrome revisited: an update on mechanisms and implications","volume":"33","author":"Diamanti-Kandarakis","year":"2012","journal-title":"Endocr Rev"},{"key":"2024041923065648200_dgad590-B18","doi-asserted-by":"crossref","first-page":"116940","DOI":"10.1016\/j.lfs.2019.116940","article-title":"Hyperandrogenemia and insulin resistance: the chief culprit of polycystic ovary syndrome","volume":"236","author":"Wang","year":"2019","journal-title":"Life Sci"},{"issue":"11","key":"2024041923065648200_dgad590-B19","doi-asserted-by":"crossref","first-page":"5110","DOI":"10.1210\/jc.2010-0917","article-title":"Health status of adults with congenital adrenal hyperplasia: a cohort study of 203 patients","volume":"95","author":"Arlt","year":"2010","journal-title":"J Clin Endocrinol Metab"},{"issue":"2","key":"2024041923065648200_dgad590-B20","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1046\/j.1365-2265.1997.1050916.x","article-title":"Ovarian hyperthecosis, diabetes and hirsuties in post-menopausal women","volume":"46","author":"Barth","year":"1997","journal-title":"Clin Endocrinol (Oxf)"},{"issue":"4","key":"2024041923065648200_dgad590-B21","doi-asserted-by":"crossref","first-page":"444","DOI":"10.4239\/wjd.v5.i4.444","article-title":"Type 2 diabetes and cardiovascular disease: have all risk factors the same strength?","volume":"5","author":"Mart\u00edn-Tim\u00f3n","year":"2014","journal-title":"World J Diabetes"},{"issue":"5","key":"2024041923065648200_dgad590-B22","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1016\/j.fertnstert.2022.03.014","article-title":"Heart health in polycystic ovary syndrome: time to act on the data","volume":"117","author":"Dokras","year":"2022","journal-title":"Fertil Steril"},{"key":"2024041923065648200_dgad590-B23","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.maturitas.2020.05.013","article-title":"Polycystic ovary syndrome and aging: health implications after menopause","volume":"139","author":"Helvaci","year":"2020","journal-title":"Maturitas"},{"issue":"10292","key":"2024041923065648200_dgad590-B24","doi-asserted-by":"crossref","first-page":"2385","DOI":"10.1016\/S0140-6736(21)00684-X","article-title":"The lancet women and cardiovascular disease commission: reducing the global burden by 2030","volume":"397","author":"Vogel","year":"2021","journal-title":"Lancet"},{"issue":"25","key":"2024041923065648200_dgad590-B25","doi-asserted-by":"crossref","first-page":"e506","DOI":"10.1161\/CIR.0000000000000912","article-title":"Menopause transition and cardiovascular disease risk: implications for timing of early prevention: A scientific statement from the American heart association","volume":"142","author":"El Khoudary","year":"2020","journal-title":"Circulation"},{"issue":"2","key":"2024041923065648200_dgad590-B26","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1016\/j.ecl.2013.02.003","article-title":"Endogenous sex steroid levels and cardiovascular disease in relation to the menopause: a systematic review","volume":"42","author":"Crandall","year":"2013","journal-title":"Endocrinol Metab Clin North Am"},{"key":"2024041923065648200_dgad590-B27","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.maturitas.2017.08.003","article-title":"Gaps, limitations and new insights on endogenous estrogen and follicle stimulating hormone as related to risk of cardiovascular disease in women traversing the menopause: A narrative review","volume":"104","author":"El Khoudary","year":"2017","journal-title":"Maturitas"},{"key":"2024041923065648200_dgad590-B28","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.crphys.2021.03.003","article-title":"Signalling mechanisms in the cardiovascular protective effects of estrogen: with a focus on rapid\/membrane signalling","volume":"4","author":"Ni\u021b\u0103","year":"2021","journal-title":"Curr Res Physiol"},{"issue":"10","key":"2024041923065648200_dgad590-B29","doi-asserted-by":"crossref","first-page":"1242","DOI":"10.1161\/01.CIR.0000157697.54255.CE","article-title":"Sex-hormone-binding globulin and the free androgen index are related to cardiovascular risk factors in multiethnic premenopausal and perimenopausal women enrolled in the Study of Women Across the Nation (SWAN)","volume":"111","author":"Sutton-Tyrrell","year":"2005","journal-title":"Circulation"},{"issue":"2","key":"2024041923065648200_dgad590-B30","doi-asserted-by":"crossref","first-page":"1202","DOI":"10.1210\/jc.2004-0744","article-title":"Endogenous postmenopausal hormones and serum lipids: the atherosclerosis risk in communities study","volume":"90","author":"Mudali","year":"2005","journal-title":"J Clin Endocrinol Metab"},{"issue":"2","key":"2024041923065648200_dgad590-B31","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.metabol.2011.06.005","article-title":"Circulating androgen levels are associated with subclinical atherosclerosis and arterial stiffness in healthy recently menopausal women","volume":"61","author":"Creatsa","year":"2012","journal-title":"Metab Clin Exp"},{"issue":"1","key":"2024041923065648200_dgad590-B32","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1097\/gme.0b013e318221bc8d","article-title":"The perimenopausal atherosclerosis transition: relationships between calcified and noncalcified coronary, aortic, and carotid atherosclerosis and risk factors and hormone levels","volume":"19","author":"Munir","year":"2012","journal-title":"Menopause"},{"issue":"6","key":"2024041923065648200_dgad590-B33","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1097\/GME.0000000000000822","article-title":"Free androgen index as a determinant of arterial stiffness in menopause: a mediation analysis","volume":"24","author":"Lambrinoudaki","year":"2017","journal-title":"Menopause"},{"issue":"22","key":"2024041923065648200_dgad590-B34","doi-asserted-by":"crossref","first-page":"2555","DOI":"10.1016\/j.jacc.2018.01.083","article-title":"Endogenous sex hormones and incident cardiovascular disease in post-menopausal women","volume":"71","author":"Zhao","year":"2018","journal-title":"J Am Coll Cardiol"},{"issue":"4","key":"2024041923065648200_dgad590-B35","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1530\/EJE-10-0307","article-title":"Low testosterone levels predict all-cause mortality and cardiovascular events in women: a prospective cohort study in German primary care patients","volume":"163","author":"Sievers","year":"2010","journal-title":"Eur J Endocrinol"},{"issue":"6","key":"2024041923065648200_dgad590-B36","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1097\/GME.0b013e318279bd4a","article-title":"Endogenous estrogen and androgen levels are not independent predictors of lipid levels in postmenopausal women","volume":"20","author":"Worsley","year":"2013","journal-title":"Menopause"},{"issue":"4","key":"2024041923065648200_dgad590-B37","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1016\/j.maturitas.2015.08.009","article-title":"Association of sex hormones with incident 10-year cardiovascular disease and mortality in women","volume":"82","author":"Schaffrath","year":"2015","journal-title":"Maturitas"},{"issue":"2","key":"2024041923065648200_dgad590-B38","doi-asserted-by":"crossref","first-page":"e109","DOI":"10.1016\/S2666-7568(22)00001-0","article-title":"Associations between blood sex steroid concentrations and risk of major adverse cardiovascular events in healthy older women in Australia: a prospective cohort substudy of the ASPREE trial","volume":"3","author":"Islam","year":"2022","journal-title":"Lancet Healthy Longev"},{"issue":"7","key":"2024041923065648200_dgad590-B39","doi-asserted-by":"crossref","first-page":"3847","DOI":"10.1210\/jc.2005-0212","article-title":"Androgen levels in adult females: changes with age, menopause, and oophorectomy","volume":"90","author":"Davison","year":"2005","journal-title":"J Clin Endocrinol Metab"},{"issue":"6","key":"2024041923065648200_dgad590-B40","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1001\/archgenpsychiatry.2010.55","article-title":"Longitudinal change in reproductive hormones and depressive symptoms across the menopausal transition: results from the Study of Women's Health Across the Nation (SWAN)","volume":"67","author":"Bromberger","year":"2010","journal-title":"Arch Gen Psychiatry"},{"issue":"5","key":"2024041923065648200_dgad590-B41","doi-asserted-by":"crossref","first-page":"529","DOI":"10.2217\/WHE.09.39","article-title":"Polycystic ovary syndrome, obesity and reproductive implications","volume":"5","author":"Hirschberg","year":"2009","journal-title":"Womens Health (Lond)"},{"key":"2024041923065648200_dgad590-B42","doi-asserted-by":"crossref","first-page":"741764","DOI":"10.3389\/fendo.2021.741764","article-title":"Resistance to the insulin and elevated level of androgen: A major cause of polycystic ovary syndrome","volume":"12","author":"Ding","year":"2021","journal-title":"Front Endocrinol (Lausanne)"},{"issue":"6","key":"2024041923065648200_dgad590-B43","first-page":"2001","article-title":"Insulin stimulates testosterone biosynthesis by human thecal cells from women with polycystic ovary syndrome by activating its own receptor and using inositolglycan mediators as the signal transduction system","volume":"83","author":"Nestler","year":"1998","journal-title":"J Clin Endocrinol Metab"},{"key":"2024041923065648200_dgad590-B44","doi-asserted-by":"crossref","first-page":"91","DOI":"10.2147\/IJWH.S344542","article-title":"Effect of sex hormone-binding globulin on polycystic ovary syndrome: mechanisms, manifestations, genetics, and treatment","volume":"14","author":"Xing","year":"2022","journal-title":"Int J Womens Health"},{"issue":"3","key":"2024041923065648200_dgad590-B45","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1007\/s00125-003-1324-0","article-title":"Effect of testosterone on lipolysis in human pre-adipocytes from different fat depots","volume":"47","author":"Dicker","year":"2004","journal-title":"Diabetologia"},{"issue":"1","key":"2024041923065648200_dgad590-B46","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/j.fertnstert.2006.11.088","article-title":"Effects of testosterone and estrogen treatment on lipolysis signaling pathways in subcutaneous adipose tissue of postmenopausal women","volume":"88","author":"Zang","year":"2007","journal-title":"Fertil Steril"},{"issue":"11","key":"2024041923065648200_dgad590-B47","doi-asserted-by":"crossref","first-page":"4178","DOI":"10.1210\/jc.2016-2586","article-title":"Hyperandrogenism accompanies increased intra-abdominal fat storage in normal weight polycystic ovary syndrome women","volume":"101","author":"Dumesic","year":"2016","journal-title":"J Clin Endocrinol Metab"},{"issue":"6","key":"2024041923065648200_dgad590-B48","doi-asserted-by":"crossref","first-page":"1267","DOI":"10.1016\/j.cgh.2020.09.045","article-title":"Testosterone is associated with nonalcoholic steatohepatitis and fibrosis in premenopausal women with NAFLD","volume":"19","author":"Sarkar","year":"2021","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"3","key":"2024041923065648200_dgad590-B49","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1111\/cen.13921","article-title":"Thigh and abdominal adipose tissue depot associations with testosterone levels in postmenopausal females","volume":"90","author":"Ofori","year":"2019","journal-title":"Clin Endocrinol (Oxf)"},{"issue":"12","key":"2024041923065648200_dgad590-B50","doi-asserted-by":"crossref","first-page":"2515","DOI":"10.1093\/humrep\/dex308","article-title":"Insulin resistance in a large cohort of women with polycystic ovary syndrome: a comparison between euglycaemic-hyperinsulinaemic clamp and surrogate indexes","volume":"32","author":"Tosi","year":"2017","journal-title":"Hum Reprod"},{"issue":"1","key":"2024041923065648200_dgad590-B51","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/s13048-022-01091-0","article-title":"Insulin resistance in polycystic ovary syndrome across various tissues: an updated review of pathogenesis, evaluation, and treatment","volume":"16","author":"Zhao","year":"2023","journal-title":"J Ovarian Res"},{"issue":"1","key":"2024041923065648200_dgad590-B52","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1016\/j.fertnstert.2018.09.013","article-title":"Metabolic disturbances in non-obese women with polycystic ovary syndrome: a systematic review and meta-analysis","volume":"111","author":"Zhu","year":"2019","journal-title":"Fertil Steril"},{"issue":"11","key":"2024041923065648200_dgad590-B53","doi-asserted-by":"crossref","first-page":"2619","DOI":"10.1093\/humrep\/dew243","article-title":"Insulin resistance in polycystic ovary syndrome: a systematic review and meta-analysis of euglycaemic-hyperinsulinaemic clamp studies","volume":"31","author":"Cassar","year":"2016","journal-title":"Hum Reprod"},{"issue":"4","key":"2024041923065648200_dgad590-B54","doi-asserted-by":"crossref","first-page":"E628","DOI":"10.1210\/jc.2012-3908","article-title":"Divergences in insulin resistance between the different phenotypes of the polycystic ovary syndrome","volume":"98","author":"Moghetti","year":"2013","journal-title":"J Clin Endocrinol Metab"},{"issue":"3","key":"2024041923065648200_dgad590-B55","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1016\/j.fertnstert.2016.12.017","article-title":"Normo- and hyperandrogenic women with polycystic ovary syndrome exhibit an adverse metabolic profile through life","volume":"107","author":"Pinola","year":"2017","journal-title":"Fertil Steril"},{"issue":"9","key":"2024041923065648200_dgad590-B56","doi-asserted-by":"crossref","first-page":"e3414","DOI":"10.1210\/clinem\/dgab380","article-title":"Insulin-mediated substrate use in women with different phenotypes of PCOS: the role of androgens","volume":"106","author":"Tosi","year":"2021","journal-title":"J Clin Endocrinol Metab"},{"key":"2024041923065648200_dgad590-B57","doi-asserted-by":"crossref","DOI":"10.1155\/2021\/7781823","article-title":"Pathophysiologic mechanisms of insulin secretion and signaling-related genes in etiology of polycystic ovary syndrome","volume":"2021","author":"Shaaban","year":"2021","journal-title":"Genet Res (Camb)"},{"issue":"Suppl 1","key":"2024041923065648200_dgad590-B58","doi-asserted-by":"crossref","first-page":"S16","DOI":"10.1016\/S0140-6736(15)60331-2","article-title":"Effect of insulin on AKR1C3 expression in female adipose tissue: in-vivo and in-vitro study of adipose androgen generation in polycystic ovary syndrome","volume":"385","author":"O'Reilly","year":"2015","journal-title":"Lancet"},{"issue":"5","key":"2024041923065648200_dgad590-B59","doi-asserted-by":"crossref","first-page":"2654","DOI":"10.1074\/jbc.M505311200","article-title":"Mice lacking adiponectin show decreased hepatic insulin sensitivity and reduced responsiveness to peroxisome proliferator-activated receptor gamma agonists","volume":"281","author":"Nawrocki","year":"2006","journal-title":"J Biol Chem"},{"issue":"2","key":"2024041923065648200_dgad590-B60","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1093\/humrep\/deh609","article-title":"Impaired insulin-dependent glucose metabolism in granulosa-lutein cells from anovulatory women with polycystic ovaries","volume":"20","author":"Rice","year":"2005","journal-title":"Hum Reprod"},{"issue":"7","key":"2024041923065648200_dgad590-B61","doi-asserted-by":"crossref","first-page":"1526","DOI":"10.1093\/humrep\/deu114","article-title":"Lifestyle intervention up-regulates gene and protein levels of molecules involved in insulin signaling in the endometrium of overweight\/obese women with polycystic ovary syndrome","volume":"29","author":"Ujvari","year":"2014","journal-title":"Hum Reprod"},{"key":"2024041923065648200_dgad590-B62","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1159\/000494908","article-title":"Obesity and androgens in women","volume":"53","author":"Pasquali","year":"2019","journal-title":"Front Horm Res"},{"key":"2024041923065648200_dgad590-B63","doi-asserted-by":"crossref","DOI":"10.1177\/1179558119874042","article-title":"Obesity and polycystic ovary syndrome: implications for pathogenesis and novel management strategies","volume":"13","author":"Barber","year":"2019","journal-title":"Clin Med Insights Reprod Health"},{"issue":"6","key":"2024041923065648200_dgad590-B64","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1093\/humupd\/dms030","article-title":"Overweight, obesity and central obesity in women with polycystic ovary syndrome: a systematic review and meta-analysis","volume":"18","author":"Lim","year":"2012","journal-title":"Hum Reprod Update"},{"issue":"1","key":"2024041923065648200_dgad590-B65","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1186\/s12958-020-00576-1","article-title":"Risk of hypertension in women with polycystic ovary syndrome: a systematic review, meta-analysis and meta-regression","volume":"18","author":"Amiri","year":"2020","journal-title":"Reprod Biol Endocrinol"},{"key":"2024041923065648200_dgad590-B66","doi-asserted-by":"crossref","DOI":"10.3389\/fcvm.2022.822079","article-title":"Cardiovascular risk according to body mass index in women of reproductive age with polycystic ovary syndrome: A systematic review and meta-analysis","volume":"9","author":"Zhuang","year":"2022","journal-title":"Front Cardiovasc Med"},{"issue":"2","key":"2024041923065648200_dgad590-B67","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1111\/obr.12762","article-title":"Metabolic syndrome in polycystic ovary syndrome: a systematic review, meta-analysis and meta-regression","volume":"20","author":"Lim","year":"2019","journal-title":"Obes Rev"},{"issue":"4","key":"2024041923065648200_dgad590-B68","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1093\/humupd\/dmy007","article-title":"Ethnicity, obesity and the prevalence of impaired glucose tolerance and type 2 diabetes in PCOS: a systematic review and meta-regression","volume":"24","author":"Kakoly","year":"2018","journal-title":"Hum Reprod Update"},{"issue":"6","key":"2024041923065648200_dgad590-B69","doi-asserted-by":"crossref","first-page":"942","DOI":"10.1093\/humupd\/dmaa029","article-title":"Long-term cardiometabolic disease risk in women with PCOS: a systematic review and meta-analysis","volume":"26","author":"Wekker","year":"2020","journal-title":"Hum Reprod Update"},{"issue":"2","key":"2024041923065648200_dgad590-B70","doi-asserted-by":"crossref","first-page":"1481","DOI":"10.1016\/j.dsx.2019.01.002","article-title":"The association between metabolic syndrome and polycystic ovary syndrome: A systematic review and meta-analysis","volume":"13","author":"Otaghi","year":"2019","journal-title":"Diabetes Metab Syndr"},{"issue":"4","key":"2024041923065648200_dgad590-B71","doi-asserted-by":"crossref","first-page":"2747","DOI":"10.1016\/j.dsx.2019.06.008","article-title":"The prevalence of metabolic syndrome in patients with polycystic ovary syndrome: A systematic review and meta-analysis","volume":"13","author":"Khorshidi","year":"2019","journal-title":"Diabetes Metab Syndr"},{"issue":"6","key":"2024041923065648200_dgad590-B72","doi-asserted-by":"crossref","first-page":"2120","DOI":"10.1210\/jc.2013-4170","article-title":"Hyperandrogenic oligomenorrhea and metabolic risks across menopausal transition","volume":"99","author":"Polotsky","year":"2014","journal-title":"J Clin Endocrinol Metab"},{"issue":"1","key":"2024041923065648200_dgad590-B73","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1080\/09513590.2019.1650337","article-title":"Cardiovascular events among reproductive and menopausal age women with polycystic ovary syndrome: a systematic review and meta-analysis","volume":"36","author":"Ramezani Tehrani","year":"2020","journal-title":"Gynecol Endocrinol"},{"issue":"9","key":"2024041923065648200_dgad590-B74","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1089\/jwh.2015.5441","article-title":"Cardiovascular disease and 10-year mortality in postmenopausal women with clinical features of polycystic ovary syndrome","volume":"25","author":"Merz","year":"2016","journal-title":"J Womens Health (Larchmt)"},{"key":"2024041923065648200_dgad590-B75","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/j.ejogrb.2022.02.020","article-title":"Morbidity and mortality in PCOS: A prospective follow-up up to a mean age above 80 years","volume":"271","author":"Forslund","year":"2022","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"issue":"5","key":"2024041923065648200_dgad590-B76","first-page":"893","article-title":"Postmenopausal hyperthecosis: functional dysregulation of androgenesis in climacteric ovary","volume":"99","author":"Krug","year":"2002","journal-title":"Obstet Gynecol"},{"issue":"10","key":"2024041923065648200_dgad590-B77","doi-asserted-by":"crossref","first-page":"2519","DOI":"10.3390\/diagnostics12102519","article-title":"Acanthosis Nigricans: pointer of endocrine entities","volume":"12","author":"Radu","year":"2022","journal-title":"Diagnostics (Basel)"},{"issue":"1","key":"2024041923065648200_dgad590-B78","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1530\/EJE-17-0111","article-title":"Discriminating between virilizing ovary tumors and ovary hyperthecosis in postmenopausal women: clinical data, hormonal profiles and image studies","volume":"177","author":"Yance","year":"2017","journal-title":"Eur J Endocrinol"},{"issue":"12","key":"2024041923065648200_dgad590-B79","doi-asserted-by":"crossref","first-page":"2785","DOI":"10.1002\/ijc.29950","article-title":"Adrenocortical tumors and insulin resistance: what is the first step?","volume":"138","author":"Altieri","year":"2016","journal-title":"Int J Cancer"},{"issue":"9","key":"2024041923065648200_dgad590-B80","doi-asserted-by":"crossref","first-page":"3520","DOI":"10.1210\/JC.2015-2093","article-title":"Increased cardiovascular and metabolic morbidity in patients with 21-hydroxylase deficiency: A Swedish population-based national cohort study","volume":"100","author":"Falhammar","year":"2015","journal-title":"J Clin Endocrinol Metab"},{"issue":"11","key":"2024041923065648200_dgad590-B81","doi-asserted-by":"crossref","first-page":"4097","DOI":"10.1210\/jc.2018-01862","article-title":"Cardiovascular and metabolic outcomes in congenital adrenal hyperplasia: A systematic review and meta-analysis","volume":"103","author":"Tamhane","year":"2018","journal-title":"J Clin Endocrinol Metab"},{"issue":"12","key":"2024041923065648200_dgad590-B82","first-page":"e5247","article-title":"Cardiovascular disease risk factors and metabolic morbidity in a longitudinal study of congenital adrenal hyperplasia","volume":"106","author":"Torky","year":"2021","journal-title":"J Clin Endocrinol Metab"},{"key":"2024041923065648200_dgad590-B83","doi-asserted-by":"crossref","first-page":"388","DOI":"10.3389\/fendo.2019.00388","article-title":"Polycystic ovary syndrome and NC-CAH: distinct characteristics and common findings. A systematic review","volume":"10","author":"Papadakis","year":"2019","journal-title":"Front Endocrinol (Lausanne)"},{"issue":"1","key":"2024041923065648200_dgad590-B84","doi-asserted-by":"crossref","first-page":"141","DOI":"10.2337\/diacare.22.1.141","article-title":"Prevalence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome","volume":"22","author":"Ehrmann","year":"1999","journal-title":"Diabetes Care"},{"issue":"11","key":"2024041923065648200_dgad590-B85","doi-asserted-by":"crossref","first-page":"2279","DOI":"10.1093\/humrep\/dex294","article-title":"The prevalence of type 2 diabetes is not increased in normal-weight women with PCOS","volume":"32","author":"Pelanis","year":"2017","journal-title":"Hum Reprod"},{"issue":"1","key":"2024041923065648200_dgad590-B86","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1210\/jcem-67-1-144","article-title":"Hyperinsulinemia and stromal luteinization of the ovaries in postmenopausal women with endometrial cancer","volume":"67","author":"Nagamani","year":"1988","journal-title":"J Clin Endocrinol Metab"},{"key":"2024041923065648200_dgad590-B87","article-title":"Diagnostic challenges in ovarian hyperthecosis: clinical presentation with subdiagnostic testosterone levels","volume":"2022","author":"Shah","year":"2022","journal-title":"Case Rep Endocrinol"},{"issue":"5","key":"2024041923065648200_dgad590-B88","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.1210\/jc.2010-1991","article-title":"Gonadotropin-releasing hormone agonist treatment in postmenopausal women with hyperandrogenism of ovarian origin","volume":"96","author":"Vollaard","year":"2011","journal-title":"J Clin Endocrinol Metab"},{"issue":"1","key":"2024041923065648200_dgad590-B89","doi-asserted-by":"crossref","first-page":"138","DOI":"10.3803\/EnM.2021.1328","article-title":"Epidemiology and long-term adverse outcomes in Korean patients with congenital adrenal hyperplasia: A nationwide study","volume":"37","author":"Kim","year":"2022","journal-title":"Endocrinol Metab (Seoul)"},{"key":"2024041923065648200_dgad590-B90","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.molmet.2018.05.008","article-title":"Sex differences in lipid and lipoprotein metabolism","volume":"15","author":"Palmisano","year":"2018","journal-title":"Mol Metab"},{"issue":"10","key":"2024041923065648200_dgad590-B91","doi-asserted-by":"crossref","first-page":"1998","DOI":"10.1097\/HJH.0b013e3283630362","article-title":"Arterial stiffness is increased in asymptomatic nondiabetic postmenopausal women with a polycystic ovary syndrome phenotype","volume":"31","author":"Armeni","year":"2013","journal-title":"J Hypertens"},{"issue":"2","key":"2024041923065648200_dgad590-B92","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1111\/jog.14543","article-title":"Arterial stiffness measured by cardio-ankle vascular index is greater in non-obese young women with polycystic ovarian syndrome","volume":"47","author":"Kilic","year":"2021","journal-title":"J Obstet Gynaecol Res"},{"issue":"4","key":"2024041923065648200_dgad590-B93","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1152\/japplphysiol.00583.2022","article-title":"Effects of androgen excess and body mass index on endothelial function in women with polycystic ovary syndrome","volume":"134","author":"Berbrier","year":"2023","journal-title":"J Appl Physiol"},{"issue":"5","key":"2024041923065648200_dgad590-B94","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1016\/j.fertnstert.2022.02.028","article-title":"Subclinical cardiovascular disease and polycystic ovary syndrome","volume":"117","author":"Gomez","year":"2022","journal-title":"Fertil Steril"},{"issue":"10","key":"2024041923065648200_dgad590-B95","doi-asserted-by":"crossref","first-page":"2374.","DOI":"10.3390\/biomedicines10102374","article-title":"Insulin resistance and high blood pressure: mechanistic insight on the role of the kidney","volume":"10","author":"Brosolo","year":"2022","journal-title":"Biomedicines"},{"issue":"6","key":"2024041923065648200_dgad590-B96","doi-asserted-by":"crossref","first-page":"1702","DOI":"10.1016\/j.fertnstert.2006.05.038","article-title":"Obesity and insulin resistance but not hyperandrogenism mediates vascular dysfunction in women with polycystic ovary syndrome","volume":"86","author":"Dokras","year":"2006","journal-title":"Fertil Steril"},{"issue":"12","key":"2024041923065648200_dgad590-B97","doi-asserted-by":"crossref","first-page":"9818.","DOI":"10.3390\/ijms24129818","article-title":"Molecular mechanisms for the vicious cycle between insulin resistance and the inflammatory response in obesity","volume":"24","author":"Szukiewicz","year":"2023","journal-title":"Int J Mol Sci"},{"issue":"3","key":"2024041923065648200_dgad590-B98","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.1016\/j.fertnstert.2010.11.036","article-title":"Circulating inflammatory markers in polycystic ovary syndrome: a systematic review and metaanalysis","volume":"95","author":"Escobar-Morreale","year":"2011","journal-title":"Fertil Steril"},{"issue":"6","key":"2024041923065648200_dgad590-B99","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1093\/humupd\/dmr025","article-title":"Meta-analysis of cardiovascular disease risk markers in women with polycystic ovary syndrome","volume":"17","author":"Toulis","year":"2011","journal-title":"Hum Reprod Update"},{"key":"2024041923065648200_dgad590-B100","article-title":"Dysregulation of immune response in PCOS organ system","volume":"14","author":"Wang","year":"2023","journal-title":"Front Immunol"},{"issue":"3","key":"2024041923065648200_dgad590-B101","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0151960","article-title":"Insulin resistance in PCOS patients enhances oxidative stress and leukocyte adhesion: role of myeloperoxidase","volume":"11","author":"Victor","year":"2016","journal-title":"PLoS One"},{"key":"2024041923065648200_dgad590-B102","article-title":"Oxidative stress: the nexus of obesity and cognitive dysfunction in diabetes","volume":"14","author":"Li","year":"2023","journal-title":"Front Endocrinol (Lausanne)"},{"issue":"5","key":"2024041923065648200_dgad590-B103","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1111\/cen.13808","article-title":"Inter-related effects of insulin resistance, hyperandrogenism, sympathetic dysfunction and chronic inflammation in PCOS","volume":"89","author":"Shorakae","year":"2018","journal-title":"Clin Endocrinol (Oxf)"},{"issue":"6","key":"2024041923065648200_dgad590-B104","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1016\/S0039-6060(03)00410-0","article-title":"Androgen-secreting adrenal tumors","volume":"134","author":"Cordera","year":"2003","journal-title":"Surgery"},{"issue":"3","key":"2024041923065648200_dgad590-B105","doi-asserted-by":"crossref","first-page":"356","DOI":"10.4183\/aeb.2017.356","article-title":"MENOPAUSAL ANDROGEN EXCESS\u2014ASSOCIATED CARDIO-METABOLIC RISK: CLUES FOR OVARIAN LEYDIG CELL TUMOUR (CASE REPORT AND MINI-REVIEW OF LITERATURE)","volume":"13","author":"Gheorghisan-Galateanu","year":"2017","journal-title":"Acta Endocrinol (Buchar)"},{"issue":"12","key":"2024041923065648200_dgad590-B106","doi-asserted-by":"crossref","first-page":"2791","DOI":"10.1093\/humrep\/dew228","article-title":"Should we individualize lipid profiling in women with polycystic ovary syndrome?","volume":"31","author":"Sundstr\u00f6m Poromaa","year":"2016","journal-title":"Hum Reprod"},{"issue":"1","key":"2024041923065648200_dgad590-B107","doi-asserted-by":"crossref","first-page":"e3464","DOI":"10.1002\/dmrr.3464","article-title":"Metabolic syndrome and its components in different phenotypes of polycystic ovary syndrome","volume":"38","author":"Krentowska","year":"2022","journal-title":"Diabetes Metab Res Rev"},{"issue":"5","key":"2024041923065648200_dgad590-B108","doi-asserted-by":"crossref","first-page":"794","DOI":"10.1016\/j.fertnstert.2018.08.021","article-title":"Beyond fertility: polycystic ovary syndrome and long-term health","volume":"110","author":"Cooney","year":"2018","journal-title":"Fertil Steril"},{"issue":"6","key":"2024041923065648200_dgad590-B109","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1089\/jwh.2021.0608","article-title":"A systematic review and meta-analysis of the association between polycystic ovary syndrome and coronary artery calcification","volume":"31","author":"Osibogun","year":"2022","journal-title":"J Womens Health (Larchmt)"},{"issue":"3","key":"2024041923065648200_dgad590-B110","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1111\/j.1365-2265.2012.04490.x","article-title":"Endothelial function measured using flow-mediated dilation in polycystic ovary syndrome: a meta-analysis of the observational studies","volume":"78","author":"Sprung","year":"2013","journal-title":"Clin Endocrinol (Oxf)"},{"issue":"10","key":"2024041923065648200_dgad590-B111","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1038\/s41574-022-00708-0","article-title":"The interplay between diabetes mellitus and menopause: clinical implications","volume":"18","author":"Lambrinoudaki","year":"2022","journal-title":"Nat Rev Endocrinol"},{"issue":"9","key":"2024041923065648200_dgad590-B112","doi-asserted-by":"crossref","first-page":"1639","DOI":"10.1007\/s00125-008-1076-y","article-title":"Risk of myocardial infarction in men and women with type 2 diabetes in the UK: a cohort study using the general practice research database","volume":"51","author":"Mulnier","year":"2008","journal-title":"Diabetologia"},{"issue":"2, Part 1","key":"2024041923065648200_dgad590-B113","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1097\/AOG.0b013e31823f7135","article-title":"A 20-year follow-up of young women with polycystic ovary syndrome","volume":"119","author":"Carmina","year":"2012","journal-title":"Obstet Gynecol"},{"issue":"4","key":"2024041923065648200_dgad590-B114","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1016\/S0015-0282(99)00641-X","article-title":"Serum testosterone levels decrease in middle age in women with the polycystic ovary syndrome","volume":"73","author":"Winters","year":"2000","journal-title":"Fertil Steril"},{"issue":"5","key":"2024041923065648200_dgad590-B115","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1016\/j.metabol.2016.01.006","article-title":"Metabolic profile in women with polycystic ovary syndrome across adult life","volume":"65","author":"Echibur\u00fa","year":"2016","journal-title":"Metab Clin Exp"},{"issue":"9","key":"2024041923065648200_dgad590-B116","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0137609","article-title":"Trend of cardio-metabolic risk factors in polycystic ovary syndrome: A population-based prospective cohort study","volume":"10","author":"Ramezani Tehrani","year":"2015","journal-title":"PLoS One"},{"issue":"6","key":"2024041923065648200_dgad590-B117","doi-asserted-by":"crossref","first-page":"1078","DOI":"10.1016\/j.fertnstert.2017.09.004","article-title":"Polycystic ovary syndrome is a risk factor for diabetes and prediabetes in middle-aged but not elderly women: a long-term population-based follow-up study","volume":"108","author":"Kazemi Jaliseh","year":"2017","journal-title":"Fertil Steril"},{"issue":"4","key":"2024041923065648200_dgad590-B118","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1007\/s42000-020-00211-z","article-title":"Insulin resistance, androgens, and lipids are gradually improved in an age-dependent manner in lean women with polycystic ovary syndrome: insights from a large Caucasian cohort","volume":"19","author":"Livadas","year":"2020","journal-title":"Hormones (Athens)"},{"issue":"4","key":"2024041923065648200_dgad590-B119","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1111\/j.1365-2265.2012.04438.x","article-title":"No metabolic impact of surgical normalization of hyperandrogenism in postmenopausal women with ovarian androgen-secreting tumours","volume":"78","author":"Pelusi","year":"2013","journal-title":"Clin Endocrinol (Oxf)"},{"issue":"12","key":"2024041923065648200_dgad590-B120","doi-asserted-by":"crossref","first-page":"E2715","DOI":"10.1210\/jc.2014-2957","article-title":"Increased mortality in patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiency","volume":"99","author":"Falhammar","year":"2014","journal-title":"J Clin Endocrinol Metab"},{"issue":"4","key":"2024041923065648200_dgad590-B121","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1530\/EJE-17-0895","article-title":"Poor compliance and increased mortality, depression and healthcare costs in patients with congenital adrenal hyperplasia","volume":"178","author":"Jenkins-Jones","year":"2018","journal-title":"Eur J Endocrinol"}],"container-title":["The Journal of Clinical Endocrinology &amp; Metabolism"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jcem\/advance-article-pdf\/doi\/10.1210\/clinem\/dgad590\/52627481\/dgad590.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jcem\/article-pdf\/109\/5\/1202\/57285774\/dgad590.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jcem\/article-pdf\/109\/5\/1202\/57285774\/dgad590.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,19]],"date-time":"2024-04-19T23:08:56Z","timestamp":1713568136000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jcem\/article\/109\/5\/1202\/7330876"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,27]]},"references-count":121,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2023,10,27]]},"published-print":{"date-parts":[[2024,4,19]]}},"URL":"https:\/\/doi.org\/10.1210\/clinem\/dgad590","relation":{},"ISSN":["0021-972X","1945-7197"],"issn-type":[{"value":"0021-972X","type":"print"},{"value":"1945-7197","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,5]]},"published":{"date-parts":[[2023,10,27]]}}}