The grant was renewed in 1996 to determine whether women with PCOS have evidence of an increased prevalence rate of subclinical atherosclerosis. Within the PCOS population the investigators performed five studies to further determine risk factors for subclinical atherosclerosis. First, they evaluated the relationship between PCOS and subclinical atherosclerosis as measured by carotid ultrasound. In this study, they determined whether women, thirty years of age or older with PCOS, had a higher prevalence of subclinical atherosclerosis than age-matched control women. Second, they evaluated the relationship between PCOS and subclinical vascular disease as measured by brachial artery flow mediated vasodilation. They determined whether PCOS cases had lower brachial artery flow mediated vasodilation than controls, and whether the distribution of flow mediated vasodilation was related to the extent of carotid artery wall thickness and plaque. Third, they evaluated whether subclinical atherosclerosis and vascular disease were related to the following cardiovascular risk factors within PCOS cases and controls: HDL cholesterol, LDL cholesterol, triglycerides, insulin, systolic and diastolic blood pressure and testosterone, waist-to-hip ratio and body mass index (BMI). Fourth, they assessed differences in body composition between PCOS cases and control women, including intra-abdominal fat as measured by computed tomography (CT) of the abdomen and sagittal diameter, and percent body fat as measured by dual energy x-ray absorptiometry (DEXA). They evaluated the relationship between subclinical atherosclerosis and body composition separately for cases and for controls. Previous studies had clearly shown that PCOS women were different from obese non-PCOS women. Moreover, insulin, testosterone and coronary heart disease risk factors were also correlated with these measures using paired t-tests. Multiple regression was used to test whether PCOS cases compared to controls had an increase in intra-abdominal fat which was independent of important confounders. Fifth, they compared plasma levels of selected coagulation factors including fibrinogen and factor VII to fibrinolytic factors for PCOS cases and controls.