**4. Cardiovascular disease in PCOS**

Several studies have shown that the odds ratio for cardiovascular disease (CVD) is significantly higher in women with PCOS compared to the control women [33–35]. Whether women with PCOS suffer from higher mortality from CVD is still unclear, pending high-quality data. Obesity is frequently observed in women with PCOS, but, even after BMI adjustment, the increased risk for cardiovascular events in PCOS persists, suggesting that additional factors play a role in mediating the higher prevalence of CVD in women with PCOS [35]. Hypertension, the most important modifiable cardiovascular risk factor for cardiovascular disease, is commonly diagnosed in women with PCOS. Moreover, insulin resistance, another risk factor for CVD, is also frequently present in women with PCOS, and independent of those subjects' BMI. Data from clinical and basic research suggest that hyperandrogenism may underlie these cardinal cardiovascular risk factors in patients with PCOS. Below we describe whether and how androgens mediate the increases in BP and IR in women with PCOS.
