Cardiometabolic Risk Factors and Its Association with Hyperandrogenemia Among Sudanese Reproductive Women with Polycystic Ovary Syndrome

Background: Risk factors for cardiovascular disease (CVD) are more common and frequently occur among PCOS women. The objective of this study was to evaluate atherogenic index of plasma (AIP) as a predictor of CVD and its association with hyperandrogenemia among PCOS women. Methods and Results: This hospital-based study, conducted in Khartoum (Sudan) from October 2020 to September 2021, used a case-control design. The patients (n=150) were women with diagnosed PCOS, according to Rotterdam criteria. The controls were 150 infertile women who did not have PCOS. An ELISA reader (ASYS Expert Plus Microplate, Austria) was used to quantify serum insulin, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and anti-Mullerian hormone (AMH) by indirect methods and total testosterone (TT) by competitive method during the follicular phase of the menstrual cycle. Serum samples of total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and fasting plasma glucose (FPG) were assayed on the Cobas c311 system (Roche Diagnostics GmbH, Germany). The triglyceride-glucose index (TyGI) and TyGI-BMI, as a marker for insulin resistance (IR), were calculated. The logarithmically converted ratio of the molar concentrations of TG to HDL-C was used to determine the AIP. Low CVD risk was defined as < 0.1, medium risk as 0.1. 0.24 and high risk as > 0.24. PCOS women had a significant increase in BMI, compared to non-PCOS (P < 0.05). Moreover, 73.4% of PCOS women were overweight to obese. PCOS women were found to have significantly increased serum levels of TC, TG, and LDL-C, as well as significantly increased levels of HOMA-IR and AIP, and a significantly decreased level of HDL-C, compared with nonPCOS women. Overall, among PCOS women, 30.0% had high TC (>= 200 mg/dL), 24.7% - high TG (>= 150 mg/dL), 29.3% - high LDL-C (>= 130 mg/dL), and 46.7% - lower HDL-C (< 40 mg/dL). Moreover, 40.6% of PCOS women had medium-to-high CVD risk, and their mean AIP was > 0.1. PCOS women with hyperandrogenemia showed significantly increased AIP and decreased HDL-C. Additionally, about 73% of PCOS women with hyperandrogenemia had lower HDL-C, and 29.9% had a high risk of CVD (AIP > 0.24). A Spearman correlation revealed that PCOS women's TT correlates positively with TC, TG, TyGI, and AIP and inversely correlates with HDL-C. AIP positively correlates with TT, TC, TyGI, and TyGI-BMI index. Conclusion: Our data revealed a significant occurrence of hyperandrogenemia, dyslipidemia, AIP, and obesity, all of which are considered risk factors for CVD in PCOS women. PCOS women should be screened, diagnosed, and treated early, which will almost certainly reduce the overall burden of CVD.