Women with polycystic ovary syndrome (PCOS) frequently exhibit central obesity, glucose intolerance, atherogenic dyslipidemia and hypertension, which are characteristic features of a condition of cardiometabolic risk. Our objective was to investigate the relationship between visceral adiposity index (VAI) and phenotypic characteristics in women with PCOS.

We conducted a cross-sectional case–control study in our Endocrinology Outpatients Clinic. A total of 220 women with PCOS (Rotterdam definition) and 144 age- and BMI-matched healthy women were studied. We evaluated hyperandrogenemia and clinical hyperandrogenism, ovarian morphology, hypothalamic–hypophyseal axis and metabolic syndrome parameters. An oral glucose tolerance test (75 g glucose) measured areas under the curve (AUC) for insulin (AUC_2h-insulin) and for glucose (AUC_2h-glucose). Homeostasis model assessment of insulin resistance, the Matsuda index of insulin resistance and VAI were determined.

Of all the variables examined, at multivariate analysis, only AUC_2h-insulin [odds ratio (OR): 1.00; 95% confidence interval (CI): 1.00–1.00; P = 0.003] and VAI score (OR: 1.81; 95% CI: 1.20–2.73; P = 0.005) showed an independent association with PCOS. All phenotypes with oligomenorrhea showed a higher VAI score than the control group (oligomenorrhea + hyperandrogenism: 2.49 � 1.46 versus 1.62 � 0.84, P < 0.001; oligomenorrhea + polycystic ovary morphology: 2.25 � 1.4 versus 1.62 � 0.84, P = 0.001; complete phenotype: 2.45 � 1.63 versus 1.62 � 0.84, P < 0.001).

Our data suggest that VAI could be an easy and useful tool in daily clinical practice and in population studies for the assessment of cardiometabolic risk associated with PCOS.