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/m2 vs. 29·1 ± 2·9 kg/m2, 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.