Exploration of Cardiology

Table 2. Clinical implications of resting heart rate and HRV in PCOS.

Category	Parameter	Physiological meaning	Association with PCOS	Potential clinical utility
RHR	RHR (> 80–100 bpm)	Global marker of autonomic balance; reflects sympathetic predominance	Higher in PCOS, even in the absence of overt CVD	Simple, low-cost supportive screening marker
HRV—time domain	SDNN	Overall autonomic variability	Reduced in PCOS	Identifies reduced autonomic flexibility
	rMSSD	Parasympathetic (vagal) activity	Reduced in PCOS	Early marker of vagal withdrawal
	pNN50	Beat-to-beat vagal modulation	Reduced in PCOS	Sensitive parasympathetic index
HRV—frequency domain	HF power/HFnu	Parasympathetic activity	Decrease in PCOS	Reflects vagal tone
	LF power/LFnu	Mixed sympathetic–parasympathetic modulation	Increase in PCOS	Indicates sympathetic influence
	LF/HF ratio	Sympatho-vagal balance	Elevated in PCOS	Detects sympathetic dominance
Direct Sympathetic Measure	MSNA	Peripheral sympathetic nerve activity	Increased, correlated with testosterone	Research-grade mechanistic insight
Ambulatory Metrics	Wearable-derived heart rate/HRV	Longitudinal autonomic trends	Limited but promising	Population-level screening & monitoring

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CVD: cardiovascular disease; HF: high frequency; HFnu: HF normalized units; HRV: heartrate variability; LF: low frequency; LFnu: LF normalized units; MSNA: muscle sympathetic nerve activity; PCOS: polycystic ovary syndrome; PNN50: percentage of NN intervals greater than 50 milliseconds; RHR: resting heart rate; rMSSD: root mean square of successive differences; SDNN: standard deviation of NN intervals.

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AWI: Conceptualization, Supervision, Writing—original draft, Writing—review & editing. PM: Writing—original draft, Writing—review & editing. SB: Writing—review & editing, Supervision. HSW: Supervision, Writing—original draft, Writing—review & editing. All authors read and approved the submitted version.

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