Effectiveness of plasma atherogenic index as a predictor of cardiovascular risk in patients with metabolic syndrome and related cardiometabolic conditions: a systematic review.

Abstract

Metabolic syndrome (MetS) and cardiovascular-kidney-metabolic syndrome represent escalating global health challenges characterized by complex lipid derangements. While traditional lipid panels are standard, the atherogenic index of plasma (AIP) has emerged as a potentially superior marker for capturing the presence of small, dense low-density lipoprotein particles and overall cardiovascular risk. This systematic review evaluates the prognostic value and longitudinal risk prediction of AIP in patients with MetS and related metabolic disorders. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search was conducted across PubMed/MEDLINE, Scopus, Embase, and Web of Science through January 2026. Nine high-quality studies encompassing 197 279 patients were identified. Synthesis of the evidence consistently demonstrates that elevated baseline AIP is consistently and independently associated with major adverse cardiovascular events (hazard ratio: 1.07-1.19), acute myocardial infarction, and cardiovascular death. Longitudinal data reveal that cumulative AIP exposure significantly increases stroke risk (hazard ratio: 2.49) and coronary heart disease. Notably, in patients with diabetic kidney disease, a nonlinear 'U-shaped' association was identified, with a critical inflection point at 0.14, suggesting that both excessively high and low AIP levels correlate with increased mortality. AIP is an accessible and promising biomarker that warrants further comparative validation in predicting long-term cardiometabolic progression. These findings support further evaluation of AIP's role in clinical risk stratification, pending prospective validation and establishment of standardized thresholds across population subgroups.