Clinical Endocrinology (2007) doi: 10.1111/j.1365-2265.2007.03004.x © 2007 The Authors Journal compilation © 2007 Blackwell Publishing Ltd 1 ORIGINAL ARTICLE Blackwell Publishing Ltd Abnormal heart rate recovery after maximal cardiopulmonary exercise stress testing in young overweight women with polycystic ovary syndrome Francesco Giallauria*, Stefano Palomba†, Francesco Manguso§, Alessandra Vitelli*, Luigi Maresca*, Domenico Tafuri¶, Gaetano Lombardi‡, Annamaria Colao‡, Carlo Vigorito* and Francesco Orio‡ , ** *Department of Clinical Medicine, Cardiovascular and Immunological Sciences, Cardiac Rehabilitation Unit, University ‘Federico II’ of Naples, Naples, †Unit of Reproductive Medicine and Surgery, ‘Magna Graecia’ University of Catanzaro, Catanzaro, ‡Department of Molecular & Clinical Endocrinology and Oncology, and §Department of Clinical and Experimental Medicine, Gastroenterology Unit, University ‘Federico II’ of Naples, Naples, ¶Chair of Methods and Teaching of Sportive Activity, Faculty of Exercise Sciences and **Department of Endocrinology, Faculty of Motor Science, University ‘Parthenope’ of Naples, Naples, Italy Summary Objective Heart rate recovery (HRR) is a measure derived from exercise test, defined as the fall in heart rate during the first minute after maximal exercise. Abnormal HRR is a measure of autonomic dysfunction associated with an increased mortality. This study was performed to evaluate the HRR in polycystic ovary syndrome (PCOS). Design Prospective controlled clinical study. Patients Seventy-five PCOS women compared to 75 healthy women matched for age (21·7 ± 2·1 years vs. 21·9 ± 1·8 years, respectively) and body mass index (BMI) (29·0 ± 2·6 kg/m 2 vs. 29·1 ± 2·9 kg/m 2 , respectively). Measurements Subjects were studied for their hormonal and metabolic profile, and underwent cardiopulmonary exercise test (CPX). Results PCOS women showed a significantly reduced HRR (12·9 ± 1·8 vs. 20·4 ± 3·1 beats/min, P < 0·001) compared to healthy controls, an impairment in maximal oxygen consumption (18·0 ± 2·3 ml/kg/min vs. 29·3 ± 3·9 ml/kg/min) and in oxygen consumption at anaerobic threshold (13·6 ± 2·6 ml/kg/min vs. 24·2 ± 3·0 ml/kg/min). In PCOS women, abnormal HRR was inversely correlated to BMI (r = -0·582, P < 0·001) and to the area under the curve for insulin (r = -0·596, P < 0·001). Conclusions Our data demonstrate an abnormal HRR after maximal CPX in young overweight PCOS patients, and that HRR should be investigated as a further potential marker of increased cardiovascular risk in PCOS. (Received 2 April 2007; returned for revision 22 April 2007; finally revised 24 May 2007; accepted 22 June 2007) Introduction Polycystic ovary syndrome (PCOS) is a relatively common endocrine-metabolic disorder predominantly characterized by chronic anovulation, hyperandrogenism and insulin-resistance (IR). 1,2 Heart rate recovery (HRR) is an easily obtained measure derived from exercise stress testing and is defined as the fall in heart rate during the first minute after maximal exercise. 3 HRR is a marker of autonomic function and is directly correlated to parasympathetic activity. Abnormal HRR is an independent cardiovascular risk (CVR) factor 4 and a powerful predictor of all-cause mortality in patients with or without coronary artery disease. 5–8 PCOS is a multifaceted syndrome associated with a wide range of cardiovascular risk (CVR) factors including dyslipidaemia, hyper- tension, glucose intolerance and diabetes. 9 Although IR is not a key factor to diagnose PCOS, 10 it is clearly documented that subjects affected by this syndrome are more insulin resistant than healthy women, even taking into account body weight. 2 Moreover, in a large cohort of PCOS women, we recently documented an IR-related impairment of cardiopulmonary functional capacity compared to age- and body mass index (BMI)- matched healthy women. 11 Even if no increased mortality for cardiovascular disease (CVD) has yet been demonstrated in PCOS, 12 several observations suggest that subjects affected by this syndrome show a complex mixture of risk factors that may predispose to an elevated CVR. 13–15 Abnormal autonomic function as evaluated by HRR is strongly associated with elevated fasting plasma glucose levels 16 and with diabetes. 17 It has also been reported that in diabetic patients, an abnormal HRR was independently predictive of cardiovascular and all-cause deaths. 18 To date, there are no data available regarding autonomic function assessment in PCOS. Therefore, this study was aimed at evaluating autonomic function as determined by end-exercise HRR in PCOS patients compared to healthy young controls. Correspondence: Francesco Orio, Faculty of Exercise Sciences, University of Naples ‘Parthenope’, Naples and Department of Molecular & Clinical Endocrinology and Oncology, University of Naples ‘Federico II’, Via S. Pansini 5, 80131 Naples, Italy. Tel: +39 3477676883; Fax: +39 0892574878; E-mail: francescoorio@virgilio.it