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00925njm 22002777a 4500 dc Annunziata, Giuseppe author Ciampaglia, Roberto author Capó Fiol, Xavier author Guerra, Fabrizia author Sureda Gomila, Antoni author Tenore, Gian Carlo author Novellino, Ettore author 2021-11 Several studies reported an increase in cardiovascular risk (CVR) in women with polycystic ovary syndrome (PCOS), considered primarily as the result of the combination of all the clinical features that characterize the syndrome, including hyperandrogenism, insulin resistance, diabetes, obesity chronic low-grade inflammation. Interestingly, in 2012 it has been proposed the so-called DOGMA theory, suggesting the pivotal role played by microbiota alteration in the development of PCOS. Subsequently, several authors evidenced the existence in PCOS women of a marked dysbiosis, which is related to the development of metabolic diseases and cardiovascular complications, mainly due to the production of bacteria-derived metabolites that interfere with various pathways. Among these, trimethylamine-N-oxide (TMAO) is emerging as one of the most important and studied microbiota-derived metabolites related to the increase in CVR, due to its pro-atherosclerotic effect. The purpose of the present review is to summarize the evidence in order to support the hypothesis that, in women with PCOS, dysbiosis might be further involved in enhancement of the CVR via contributing to the increase of circulating TMAO. Although no observational studies on a large number of patients directly investigated the serum levels of TMAO in PCOS women, this manuscript aimed to drive future studies in this field, concurring in providing a novel approach for both comprehension and treatment of the CVR in PCOS. Annunziata G, Ciampaglia R, Capo X, Guerra F, Sureda A, Tenore GC, et al. Polycystic ovary syndrome and cardiovascular risk. Could trimethylamine N-oxide (TMAO) be a major player? A potential upgrade forward in the DOGMA theory. Biomed Pharmacother. 2021 Nov;143:112171. 10.1016/j.biopha.2021.112171 1950-6007 0753-3322 Biomedicine & Pharmacotherapy https://hdl.handle.net/20.500.13003/19752 34536755 L2014591765 2-s2.0-85114941324 https://hdl.handle.net/20.500.12105/23191 696911700003 Polycystic ovary syndrome Trimethylamine N-oxide Cardiovascular risk Microbiota Dysbiosis Polycystic ovary syndrome and cardiovascular risk. Could trimethylamine N-oxide (TMAO) be a major player? A potential upgrade forward in the DOGMA theory