The Relationship Between Aortic Knob Width and Metabolic Syndrome in Women with Polycystic Ovary Syndrome

Background: Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder that elevates the risk of cardiometabolic conditions, including metabolic syndrome (MetS). Aortic knob width (AKW) is a simple radiographic marker reflecting cumulative vascular remodeling and subclinical atherosclerosis. AKW has been associated with cardiometabolic disorders in various populations. However, its clinical relevance in women with PCOS remains unclear. This study aimed to evaluate AKW in women with PCOS and investigate its relationship with MetS. Methods: This retrospective case-control study comprised 200 women diagnosed with PCOS in accordance with the Rotterdam criteria, alongside 200 healthy controls matched for age and body mass index. Clinical, anthropometric, biochemical, and hormonal parameters were recorded. AKW was measured on posteroanterior chest radiographs by two independent observers. MetS was defined based on the 2009 international consensus criteria. Associations between AKW and MetS components were assessed using correlation and covariance analyses. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of AKW in detecting MetS. Results: The AKW was significantly higher in the PCOS group than in the control group (30.43 ± 5.02 mm vs. 28.47 ± 5.21 mm, p < 0.001). The prevalence of MetS was markedly higher in women with PCOS (39%) than in the control group (9.5%). AKW increased progressively with the number of MetS components, with a more pronounced trend in the PCOS group. Significant correlations were observed between AKW and all MetS components, including blood pressure, waist circumference, fasting glucose, and triglycerides (all p < 0.001), while high-density lipoprotein cholesterol showed an inverse correlation. ROC analysis demonstrated moderate-to-good discriminatory performance of AKW for identifying MetS in women with PCOS (area under the curve: 0.80; 95% confidence interval: 0.72-0.86; p < 0.001), with an optimal cutoff value of 33.05 mm (78% sensitivity and 80% specificity). Conclusions: AKW was significantly associated with the presence and burden of metabolic syndrome among women with PCOS. Although AKW demonstrated moderate-to-good discriminatory performance for identifying MetS, prospective multicenter studies with external validation are required before its potential clinical utility can be established.