Effect of Pharmacological Interventions on Lipid Profiles and C-reactive Protein in Polycystic Ovary Syndrome

A Systematic Review and Meta-Analysis

Mohammed A. Abdalla; Najeeb Shah; Harshal Deshmukh; Amirhossein Sahebkar; Linda Östlundh; Rami H. Al-Rifai; Stephen L. Atkin; Thozhukat Sathyapalan


Clin Endocrinol. 2022;96(4):443-459. 

In This Article

Abstract and Introduction


Context: Polycystic ovary syndrome (PCOS) is a heterogeneous condition affecting women of reproductive age. It is associated with dyslipidaemia and elevated plasma C-reactive protein (CRP), which increase the risks of cardiovascular disease (CVD).

Objective: To review the existing evidence on the effects of different pharmacological interventions on lipid profiles and CRP of women with PCOS.

Data Sources: We searched PubMed, MEDLINE, Scopus, Embase, Cochrane Library, and Web of Science in April 2020 and updated the results in March 2021.

Study Selection: The study included randomized controlled trials (RCTs) and follows the 2020 Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA).

Data Extraction: Two independent researchers extracted data and assessed for risk of bias using the Cochrane risk of bias tool. Covidence systematic review software were used for blinded screening and study selection.

Data Synthesis: In 29 RCTs, there were significant reductions in triglycerides with atorvastatin versus placebo [mean difference (MD): −0.21 mmol/L; 95% confidence interval (CI): −0.39, −0.03, I 2 = 0%, moderate grade evidence]. Significant reductions were seen for low-density lipoprotein cholesterol (LDL-C) with metformin versus placebo [standardized mean difference (SMD): −0.41; 95% CI: −0.85, 0.02, I 2 = 59%, low grade evidence]. Significant reductions were also seen for total cholesterol with saxagliptin versus metformin (MD: −0.15 mmol/L; 95% CI: −0.23, −0.08, I 2 = 0%, very low grade evidence). Significant reductions in C-reactive protein (CRP) were seen for atorvastatin versus placebo (MD: −1.51 mmol/L; 95% CI: −3.26 to 0.24, I 2 = 75%, very low-grade evidence).

Conclusion: There were significant reductions in the lipid parameters when metformin, atorvastatin, saxagliptin, rosiglitazone and pioglitazone were compared with placebo or other agents. There was also a significant reduction of CRP with atorvastatin.


Polycystic ovary syndrome (PCOS) is a heterogeneous condition affecting up to 20% of women of reproductive age.[1] PCOS is characterized by signs and symptoms of androgen excess and an increase in cardiovascular risk.[2] The pathology behind this condition is unclear; however, it has been attributed to hormonal excess, environmental factors and increases in body weight.[3] Lipid abnormalities including elevated triglycerides (TGs), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC) and decreased high-density lipoprotein cholesterol (HDL-C) are common in women with PCOS with up to 70% of women with PCOS having dyslipidaemia.[4,5] Insulin resistance is also higher in obese women with PCOS, a feature of the metabolic syndrome associated with PCOS and, contributes to lipid disorders.[6] Hyperandrogenism is a feature of PCOS that is also associated with an adverse metabolic risk by increasing intra-abdominal fat deposition, which promotes the metabolic dysfunction seen in the PCOS.[7] Women with PCOS have significantly higher CRP which is an inflammatory marker and cardiovascular risk factor.[8] Dyslipidaemia and high levels of CRP are associated with an increased risk of cardiovascular disease (CVD).[9,10] Moreover, anovulation has been found to be associated with higher TC, TGs, LDL-C and lower HDL-C in women with PCOS due to an increased release of the reactive oxygen species (ROS), which leads to ovarian damage and follicular atresia.[11]

Lipid-lowering agents are occasionally used in PCOS for primary and secondary prevention of CVD. Besides lipid lowering these drugs can reduce oxidative stress and inflammation and improve other metabolic parameters in PCOS.[12] Statins can significantly reduce the levels of TC, TGs, LDL-C and CRP in women with PCOS.[13] Simvastatin and atorvastatin have synergistic effects on the lipid profiles and can improve the menstrual cyclicity of women with PCOS.[14] Therefore, this review aimed to evaluate and analyse the available evidence for the effectiveness of various therapeutic options for the treatment of dyslipidaemia seen in PCOS.