Lipid variations in different polycystic ovary syndrome phenotypes: A systematic review & meta-analysis

Background & objectives Polycystic Ovary Syndrome (PCOS) is an endocrine disorder affecting reproductive-age women worldwide. Lipid abnormalities, such as elevated low-density lipoprotein (LDL) and triglyceride (TG) levels and reduced high-density lipoprotein (HDL) levels, are commonly observed in women with PCOS, increasing their risk of cardiovascular disease (CVD). Therefore, this study aims to quantify the magnitude and pattern of lipid levels (total cholesterol, HDL, LDL, and TG) in women with different phenotypes of PCOS versus control women. Methods Worldwide published observational (cross-sectional, case-control, and cohort) studies between January 2010 and December 2024 were systematically searched and assessed using electronic databases, such as PubMed, Google Scholar, Science Direct, and Web of Science-Science Citation Index, where women suffering from different PCOS phenotypes were compared with non-PCOS controls. The association between lipid levels and PCOS was estimated by the mean difference (MD) with a 95% confidence interval (CI). Results The studies included 3655 PCOS patients (phenotype A 1907, phenotype B 474, phenotype C 764, phenotype D 510) and 1824 control participants. Women with the complete phenotype polycystic ovarian morphology plus hyperandrogenism plus ovulatory dysfunction (PCO+HA+O) had increased levels of total cholesterol, LDL cholesterol, and TGs compared to women with other PCOS phenotypes. Total cholesterol was 12.69 mg/dl [95% confidence interval (CI): 8.25, 17.13] in phenotype A. TG levels exhibited the greatest MD in phenotype A and the smallest in phenotype C when compared to control subjects. Interpretation & conclusions The study found significant differences in lipid levels among different PCOS phenotypes compared to control women, highlighting the significance of recognising these differences for cardiovascular risk management.