Comparative Evaluation of Atherogenic Markers in Metabolic versus Reproductive Phenotypes of PCOS Patients: A Systematic Review and Meta-Analysis with PMOS Modeling
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Risma Uli Malumma Sagala
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Bisma Apta Kusuma
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- Abstract
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Introduction: Polycystic ovary syndrome (PCOS) is a heterogeneous endocrine disorder associated with long-term cardiometabolic risk. This systematic review and meta-analysis evaluated atherogenic markers in a retrospectively modelled metabolic-dominant phenotype (PMOS model) and a reproductive-dominant/lean PCOS phenotype. Method: Searches were conducted in Scopus and PubMed following the PRISMA framework. Four primary studies involving 1,045 participants (three observational studies and one randomized clinical trial) were synthesized using an inverse-variance random-effects model, with risk of bias assessed using ROBINS-I and RoB 2. Discussion: For the TG/HDL ratio, both phenotype subgroups showed higher values than their respective controls (pooled SMD 0.52 for the metabolic subgroup and 0.62 for the reproductive subgroup), with no observed statistical heterogeneity (I² = 0%); however, the between-subgroup test was not significant (P = 0.73). For apolipoprotein B (ApoB), the pooled estimate was statistically significant in the metabolic subgroup (SMD 0.35; P = 0.0469), whereas the reproductive subgroup estimate was not significant (SMD 0.34; 95% CI -0.23 to 0.91; P = 0.24). The latter should not be interpreted as absence of atherogenic risk because the reproductive subgroup was represented by a small sample, resulting in a wide confidence interval and limited statistical power. Interpretation of the ApoB finding also requires caution because one contributing randomized study had high risk of bias in the deviations-from-intended-interventions domain.
Conclusion: Overall, the findings support phenotype-oriented cardiometabolic risk assessment, but do not establish a definitive difference between phenotypes; larger prospective multicentre studies, particularly in lean PCOS, are needed.
- References
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Copyright (c) 2026 Andhika Syahdan Triansyah Agus, Risma Uli Malumma Sagala, Bisma Apta Kusuma
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
