Elevated atherogenic index of plasma in multiple sclerosis: association with metabolic profile in a cross-sectional...

Multiple sclerosis (MS) is a chronic neuroimmunological disorder characterized by inflammation, demyelination, and neuroaxonal loss within the central nervous system. Recent evidence suggests that MS is not only a neuroimmune disease but also associated with systemic metabolic alterations. Furthermore, certain disease-modifying therapies (DMTs) used in MS may influence lipid metabolism, leading to changes in serum cholesterol levels. The atherogenic index of plasma (AIP), calculated based on the triglyceride-to-high density lipoprotein (HDL) cholesterol ratio, is a sensitive biomarker reflecting atherogenic burden. This study aimed to evaluate AIP and lipid profiles in patients with MS and to investigate the relationship of AIP with clinical severity and treatment characteristics.

In this retrospective cross-sectional study, 100 patients with relapsing-remitting MS (RRMS) and 100 age- and sex-matched healthy controls were included. Serum lipid parameters were measured, and AIP was calculated using the formula log10(TG/HDL). In addition to group comparisons, correlation analysis, AIP quartile analysis, receiver operating characteristic (ROC) analysis, and multivariable logistic regression analysis were performed. Patients were also stratified according to the DMTs used and their hepatic metabolic profiles.

Total cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides, and AIP levels were significantly higher in patients with MS compared to controls (all p < 0.05), whereas no significant difference was observed in HDL levels. AIP values were significantly elevated in the MS group (0.45 ± 0.26 vs. 0.37 ± 0.23; p = 0.020). The discriminative performance of AIP for MS was modest but statistically significant (AUC = 0.600, p = 0.015). In multivariable logistic regression analysis, AIP quartiles were independently associated with the presence of MS (OR = 1.356, p = 0.034). Quartile analysis demonstrated that increasing AIP levels were associated with higher total cholesterol and LDL levels and lower HDL levels (p < 0.05), while no association was found with Expanded Disability Status Scale (EDSS) scores. Correlation analysis revealed no significant relationship between AIP or lipid parameters and EDSS. No significant differences in AIP were observed among treatment groups.

Elevated AIP and an atherogenic lipid profile in patients with MS support the presence of systemic metabolic and inflammatory components in the disease. The independent association between AIP and MS supports the presence of systemic metabolic and inflammatory components in the disease. However, the lack of association between AIP and EDSS suggests that AIP may reflect systemic inflammation and metabolic burden rather than clinical disability. The limited impact of DMTs on lipid profiles indicates that the observed metabolic alterations may be primarily disease-related. Further large-scale prospective studies are warranted to clarify the clinical utility of AIP in MS.