Cardiometabolic Risk in Polycystic Ovary Syndrome: Impact of High- Sensitivity C-Reactive Protein and Atherogenic Index of Plasma

Background: Polycystic ovary syndrome (PCOS) is a multifaceted endocrine-metabolic disorder that extends beyond reproductive dysfunction to involve substantial cardiometabolic disturbances. Women with PCOS often have insulin resistance (IR), atherogenic dyslipidaemia, central obesity, and chronic low-grade inflammation (CLI), which adds to their elevated long-term cardiovascular (CV) risk. The high-sensitivity C-reactive protein (hs-CRP) is a sensitive marker of subclinical systemic inflammation, whereas the atherogenic index of plasma (AIP), which is calculated from triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C) levels, is a measure of the ratio of atherogenic and protective lipids. Thus, a composite score of hs-CRP and AIP could be useful for assessing the inflammatory and lipid load of cardiometabolic risk in women with PCOS. Methods: This is a case-control study that included 90 women with polycystic ovary syndrome and 90 apparently healthy controls. A specialist gynaecologist confirmed the diagnosis of PCOS and the phenotypes by clinical, biochemical, and/or ultrasonographic assessment. The hs-CRP level in serum was used as a marker for CLI. The lipid profile parameters were evaluated to define the lipid-related atherogenic background and subsequently the AIP. AIP was determined as log10(TG/HDL-C), and values of TG and HDL-C were expressed in molar concentrations. Results: Cardiometabolic risk burden was significantly greater in women with PCOS, as reflected by the increased levels of BMI, waist circumference (WC), hs-CRP, atherogenic lipid parameters, and AIP (p<0.001). In addition, PCOS was correlated with higher total cholesterol (TC), TG, low-density lipoprotein cholesterol (LDL-C), and Very-low-density lipoprotein (VLDL), and lower HDL-C. hs-CRP correlated positively with adiposity, IR, LDL-C, and AIP, and negatively with HDL-C, indicating a combined inflammatory and atherogenic risk pattern in women with PCOS. Conclusions: There was a specific inflammatory and atherogenic cardiometabolic burden in patients with PCOS, with a high level of hs-CRP, dyslipidaemia, and higher AIP. Inflammation, adiposity, IR, and lipid-related risk are all well correlated in PCOS, and hs-CRP and AIP could be useful in the early identification of CV risk in affected women.