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Staudt A, Kiechl SJ, Gande N, Hochmayr C, Bernar B, Stock K, Geiger R, Egger A, Griesmacher A, Knoflach M, Kiechl-Kohlendorfer U. Influence of Oral Contraceptives on Lipid Profile and Trajectories in Healthy Adolescents-Data From the EVA-Tyrol Study. J Adolesc Health 2024; 75:479-486. [PMID: 39001754 DOI: 10.1016/j.jadohealth.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 03/19/2024] [Accepted: 04/09/2024] [Indexed: 07/15/2024]
Abstract
PURPOSE Oral contraception is one of the most popular contraceptive methods both in adults and adolescents. However, the effects of oral contraception on lipids in adolescents are not well studied. METHODS Lipid profiles were measured and contraceptive use was assessed in 14- to 19-year-old female participants of the prospective population-based Early Vascular Ageing-Tyrol Study between 2015 and 2018, twice on average 22 months apart. RESULTS For this analysis, data from 828 young women with a median age of 17.0 years were available. Of them, 317 (38%) used oral contraceptives (OCs). OC users had a slightly higher systolic and diastolic blood pressure and larger changes over time and were more likely to use cigarettes than nonusers. Total cholesterol (179.6 vs. 162.4 mg/dL), low-density lipoprotein-cholesterol (106.4 vs. 94.6 mg/dL), and triglycerides (104.0 vs. 67.0 mg/dL) were significantly higher in OC users after multivariable adjustment in linear regression models. No difference in high-density lipoprotein-cholesterol between the two groups was found. In 558 females, follow-up data were available. Those who initiated OC use had on average 15.4 mg/dL higher low-density lipoprotein-cholesterol and 36.2 mg/dL higher triglyceride level changes between baseline and follow-up than never users. Duration of OC use did not show a significant association with lipid levels and changes. DISCUSSION We showed an independent association between OC use and blood lipids as well as lipid trajectories over time in a large cohort of healthy adolescents. These changes are especially relevant to consider in adolescents with other risk factors for dyslipidemia or other cardiovascular risk factors.
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Affiliation(s)
- Anna Staudt
- Department of Pediatrics II, Medical University of Innsbruck, Innsbruck, Austria
| | - Sophia J Kiechl
- VASCage, Centre on Clinical Stroke Research, Innsbruck, Austria; Department of Neurology, Hochzirl Hospital, Zirl, Austria
| | - Nina Gande
- Department of Pediatrics II, Medical University of Innsbruck, Innsbruck, Austria
| | - Christoph Hochmayr
- Department of Pediatrics II, Medical University of Innsbruck, Innsbruck, Austria
| | - Benoît Bernar
- Department of Pediatrics II, Medical University of Innsbruck, Innsbruck, Austria; Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Katharina Stock
- Department of Pediatrics III, Medical University of Innsbruck, Innsbruck, Austria
| | - Ralf Geiger
- Department of Pediatrics III, Medical University of Innsbruck, Innsbruck, Austria
| | - Alexander Egger
- Central Institute for Medical and Chemical Laboratory Diagnosis, Medical University of Innsbruck, Innsbruck, Austria
| | - Andrea Griesmacher
- Central Institute for Medical and Chemical Laboratory Diagnosis, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Knoflach
- VASCage, Centre on Clinical Stroke Research, Innsbruck, Austria; Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
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Shahnazi M, Farshbaf-Khalili A, Pourzeinali-Beilankouh S, Sadrimehr F. Effects of Second and Third Generation Oral Contraceptives on Lipid and Carbohydrate Metabolism in Overweight and Obese Women: A Randomized Triple-Blind Controlled Trial. IRANIAN RED CRESCENT MEDICAL JOURNAL 2017; 18:e36982. [PMID: 28144464 PMCID: PMC5253509 DOI: 10.5812/ircmj.36982] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 03/28/2016] [Accepted: 04/23/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Combined oral contraceptives (COCs) have not been shown to have major effects on lipid and carbohydrate metabolism in normal-weight women. However, we have limited information about the effects on women at high risk for cardiovascular disease and diabetes due to being overweight and obese. OBJECTIVES To evaluate the effects of second and third generation contraceptive pills on lipid and carbohydrate metabolism in overweight and obese women. PATIENTS AND METHODS This triple-blind controlled trial was performed on 137 healthy women aged 18 - 40 years with a body mass index of 25-34.9 (kg/m2) who were referred to health centers in Tabriz, Iran from 2014 to 2015. The women were randomly divided into groups who were to take 30 mcg ethinyl estradiol/150 mcg levonorgestrel (EE/LGN) (n = 69) or 30 mcg ethinyl estradiol/150 mcg desogestrel (EE/DSG) (n = 68) with an allocation ratio of 1: 1 for three cycles. As primary outcomes, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and fasting plasma glucose (FPG) were assessed; total cholesterol (TC), triglycerides (TG), and 2-hour plasma glucose in the 75-g oral glucose tolerance test (2-hour 75-g OGTT) were assessed as secondary outcomes. RESULTS The differences in lipid and carbohydrate parameters were not significant between the two groups, except for HDL-C (Adjusted MD (CI95%) = 7.00 (2.98 to 11.02)). HDL-C decreased with EE/LGN (P = 0.016) and increased with EE/DSG (P = 0.004). LDL-C and TC increased in both groups, whereas TG increased only with EE/DSG (P < 0.05). Compared with the baseline, FPG levels did not differ significantly in both groups, but EE/DSG increased 2-hour 75-g OGTT (P = 0.010). CONCLUSIONS We observed no significant differences between the two groups in lipid and carbohydrate metabolism, except for HDL-C. Considering the importance of overweight and obese women's health, studies with longer follow-up periods are recommended in this respect.
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Affiliation(s)
- Mahnaz Shahnazi
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Azizeh Farshbaf-Khalili
- Department of Midwifery, Nursing and Midwifery Faculty, Tabriz Health Services Management Research Centre, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Samira Pourzeinali-Beilankouh
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, IR Iran
- Corresponding Author: Samira Pourzeinali-Beilankouh, Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, IR Iran. Tel: +98-4134474467, Fax: +98-4134796969, E-mail: ,
| | - Farnaz Sadrimehr
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, IR Iran
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Farahmand M, Ramezani Tehrani F, Rostami Dovom M, Hashemi S, Azizi F. The impact of oral contraceptives on cardiometabolic parameters. J Endocrinol Invest 2016. [PMID: 26223383 DOI: 10.1007/s40618-015-0346-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE There is much controversy regarding the use of oral contraceptive pills (OCPs) on cardiometabolic parameters, which is why this longitudinal population-based study was conducted to assess the impact of OCP use and its duration on cardiometabolic factors. METHODS Of 5532 reproductive-aged participants of the Tehran lipid and glucose study, 3160 women who met our inclusion criteria were subdivided according to the duration of OCPs consumption into four sub-groups: (1) Non-users; (2) <11 month users; (3) 12-35 month users, and (4) ≥36 month users, and their cardiometabolic parameters were compared. RESULTS No statistical significant differences were observed between the cardiometabolic parameters of these sub-groups, after further adjustment for confounding factors including age, parity, and education, except for mean low-density lipoprotein-cholesterol which was significantly higher in women who used OCPs for >36 months in comparison to non-OCP users. The odds ratio of hypercholesterolemia was significantly higher in women who used OCPs for >36 months in comparison to non-OCP users; being 1.5 times higher than non-users (95 % CI 1.01-2.2). CONCLUSION Results showed that if used for less than 3 years, OCPs have no cardiometabolic effects.
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Affiliation(s)
- M Farahmand
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, 24 Parvaneh St., Yaman St., Velenjak, PO Box 19395-4763, Tehran, Islamic Republic of Iran
| | - F Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, 24 Parvaneh St., Yaman St., Velenjak, PO Box 19395-4763, Tehran, Islamic Republic of Iran.
| | - M Rostami Dovom
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, 24 Parvaneh St., Yaman St., Velenjak, PO Box 19395-4763, Tehran, Islamic Republic of Iran
| | - S Hashemi
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, 24 Parvaneh St., Yaman St., Velenjak, PO Box 19395-4763, Tehran, Islamic Republic of Iran
| | - F Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
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El-Haggar SM, Mostafa TM. Cardiovascular risk in Egyptian healthy consumers of different types of combined oral contraceptives pills: A comparative study. Endocrine 2015; 49:820-7. [PMID: 25539793 DOI: 10.1007/s12020-014-0507-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 12/05/2014] [Indexed: 12/18/2022]
Abstract
This study aimed to evaluate the associated cardiovascular risk in Egyptian healthy consumers of different types of combined oral contraceptives pills (COCPs) via determination of lipids profiles, Castelli index I, leptin, adiponectin, and resistin concentrations as cardiovascular risk factors. In this cross-sectional study, the study groups consisted of control group that represented by 30 healthy married women who were not on any contraceptive mean or any hormonal therapy and had normal menstrual cycles, group two consisted of 30 women who were users of Levonorgesterl 0.15 mg plus Ethinylestradiol 0.03 mg as 21 days cycle, group three consisted of 30 women who were users of Gestodene 0.075 mg plus Ethinylestradiol 0.03 mg as 21 days cycle, and group four consisted of 30 women who were users of Drospirenone 3 mg plus Ethinylestradiol 0.03 mg as 21 days cycle. One-way analysis of variance followed by LSD post hoc test was used for comparison of variables. P value <0.05 was considered to be significant. The comparison of the studied groups revealed that COCPs containing levonorgestrel plus ethinylestradiol resulted in significantly lower adiponectin level, and significantly higher leptin and resistin levels with more atherogenic lipid profile presented by significantly higher LDL-C, significantly lower HDL-C concentrations, and significantly higher atherogenic index. Formulation containing ethinylestradiol combined with gestodene neither altered adipose tissue function nor showed deleterious effect on lipid panel. Formulation containing ethinylestradiol combined with drospirenone resulted in significantly higher HDL-C and adiponectin concentrations. In conclusion, the uptake of COCPs containing levonorgestrel plus ethinylestradiol is associated with high cardiovascular risk since this formulation showed significantly lower adiponectin concentration, significantly higher leptin, resistin, and atherogenic index as compared to other studied groups. By contrast, the formulations containing ethinylestradiol combined with third generation progestin gestodene or fourth generation progestin drospirenone are associated with low cardiovascular risk since they neither altered adipose tissue function nor impaired lipoprotein metabolism as experienced by their favorable effect on leptin, adiponectin, and resistin, with non-changed atherogenic index, higher HDL-C levels and lower LDL-C levels as compared to levonorgestrel plus ethinylestradiol formulation.
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Affiliation(s)
- Sahar M El-Haggar
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tanta University, Tanta, Egypt,
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Abstract
Estrogen and progestins have been used by millions of women as effective combined contraceptives. The safety of hormonal contraceptives has been documented by years of follow-up and serious adverse events that may be related to their use are rare in the young population exposed to these agents. The balance between the benefits and the risks of contraceptive steroids is generally positive in particular when comparing to the risks of pregnancy and especially in women with risk factors. The metabolic changes induced by the synthetic steroids used in contraception, such as lipoprotein changes, insulin response to glucose, and coagulation factors have been considered as potential markers of cardiovascular and venous risk. Observations of these effects have led to modifications of the composition of hormonal contraceptive in order to minimize these changes and hence potentially decrease the risks. The synthetic estrogen Ethinyl-Estradiol (EE) exerts a stronger effect that natural estradiol (E2) on hepatic metabolism including estrogen-dependent markers such as liver proteins. This stronger hepatic impact of EE has been related to its 17α-ethinyl group which prevents the inactivation of the molecule and results in a more pronounced hepatic effect of EE as compared to estradiol. Due to its strong activity, administering EE via a non-oral route does not prevent its impact on liver proteins. In order to circumvent the metabolic changes induced by EE, newer products using more natural compounds such as estradiol (E2) and estradiol valerate (E2V) have been introduced. The synthetic progestins used for contraception are structurally related either to testosterone (T) (estranes and gonanes) or to progesterone (pregnanes and 19-norpregnanes). Several new progestins have been designed to bind more specifically to the progesterone receptor and to minimize side-effects related to androgenic, estrogenic or glucocorticoid receptor interactions. Dienogest (DNG), and drospirenone (DRSP) and the 19-norpregnanes including Nestorone® (NES), nomegestrol acetate (NOMAc) and trimegestone (TMG) have been combined with estrogen either EE or E2 or estradiol valerate (E2V). Risks and benefits of the newer progestins used in contraception depend upon the type of molecular structure, the type and dose of estrogen associated in a combination and the route of administration. The lower metabolic impact of estradiol-based combinations may result in an improved safety profile, but large surveillance studies are warranted to confirm this plausible hypothesis. So far, the contraindications and warnings for use of current COCs also apply to the estradiol-based COCs.
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MESH Headings
- Animals
- Carbohydrate Metabolism/drug effects
- Contraceptives, Oral, Combined/adverse effects
- Contraceptives, Oral, Combined/pharmacology
- Contraceptives, Oral, Combined/therapeutic use
- Contraceptives, Oral, Hormonal/adverse effects
- Contraceptives, Oral, Hormonal/pharmacology
- Contraceptives, Oral, Hormonal/therapeutic use
- Estrogens/adverse effects
- Estrogens/therapeutic use
- Female
- Hemostasis/drug effects
- Homeostasis/drug effects
- Humans
- Lipid Metabolism/drug effects
- Liver/drug effects
- Liver/metabolism
- Progestins/adverse effects
- Progestins/therapeutic use
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Affiliation(s)
- Regine Sitruk-Ware
- Center for Biomedical Research, Population Council, Rockefeller University, New York, NY, USA,
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Rad M, Kluft C, de Kam ML, Meijer P, Cohen AF, Grubb GS, Constantine GD, Burggraaf J. Metabolic profile of a continuous versus a cyclic low-dose combined oral contraceptive after one year of use. EUR J CONTRACEP REPR 2011; 16:85-94. [DOI: 10.3109/13625187.2011.556761] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Winkler UH, Röhm P, Höschen K. An open-label, comparative study of the effects of a dose-reduced oral contraceptive containing 0.02 mg ethinylestradiol/2 mg chlormadinone acetate on hemostatic parameters and lipid and carbohydrate metabolism variables. Contraception 2010; 81:391-400. [DOI: 10.1016/j.contraception.2009.12.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Revised: 12/03/2009] [Accepted: 12/05/2009] [Indexed: 10/19/2022]
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Hurwitz BE, Henry N, Goldberg RB. Long-term oral contraceptive treatment, metabolic syndrome and measures of cardiovascular risk in pre-menopausal women: National Health and Nutrition Examination Survey 1999-2004. Gynecol Endocrinol 2009; 25:441-9. [PMID: 19499415 DOI: 10.1080/09513590902770149] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
AIM Differences in subclinical cardiometabolic measures were examined as a function of oral contraceptive pills (OCP) treatment duration to compare never-treated women with four OCP-treatment groups (<1, 1-5, 5-10 and >10 years). METHODS The NHANES (1999-2004) database was used to evaluate 2089 healthy, pre-menopausal women, aged 18-55 years, with or without OCP history, no other hormonal treatment or history of systemic conditions. Outcome measures included body mass, central obesity, blood pressure, glycemia, insulinemia, lipid profile and inflammation. Analyses evaluated differences in prevalence of Metabolic Syndrome (MetS), constituent MetS and other clinical risk criteria, as well as outcome magnitudes. Analyses controlled for demographic and health-related variables, and study-eligible conditions. RESULTS Relative to other groups, women with >10 years OCP-use, and to some extent those with 5-10 years treatment, displayed no differences in prevalence of MetS and most risk criteria. Further analysis showed that, relative to women treated for <5 years, those with more prolonged OCP treatment displayed lower body mass and fasting glycemia with higher HDL-c levels, but more elevated LDL-c and total cholesterol. CONCLUSIONS The findings of both beneficial and detrimental subclinical cardiometabolic differences with more long-term OCP-treatment reinforces the need to monitor changes in these factors within the context of the treated patient's risk-benefit profile. However, because the magnitude of these differences was small, relative to normative ranges, it may be concluded that OCPs, as used in recent decades, are unlikely to markedly affect cardiometabolic risk.
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Affiliation(s)
- Barry E Hurwitz
- Behavioral Medicine Research Centre, University of Miami, Clinical Research Building #777, 1120 NW 14th Street, Miami, FL 33136, USA.
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Sitruk-Ware R, Plu-Bureau G, Menard J, Conard J, Kumar S, Thalabard JC, Tokay B, Bouchard P. Effects of oral and transvaginal ethinyl estradiol on hemostatic factors and hepatic proteins in a randomized, crossover study. J Clin Endocrinol Metab 2007; 92:2074-9. [PMID: 17374706 DOI: 10.1210/jc.2007-0026] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
CONTEXT The use of combined hormonal contraceptives with ethinyl estradiol (EE) and a progestin results in alterations in potential biomarkers of venous thromboembolism risk. Evaluation of the impact of delivery route on these changes is difficult due to an interaction between EE and the progestin component. OBJECTIVE The aim of the study was to compare the impact of oral and vaginal administration of EE alone on hemostatic variables and estrogen-sensitive liver proteins. DESIGN This was a single-center, randomized, crossover study with two treatment cycles separated by a washout cycle. SETTING The study was conducted in an academic outpatient center. PARTICIPANTS Fourteen healthy postmenopausal women were enrolled; 13 completed the study and were included in the analyses. INTERVENTION Participants were randomized to receive EE (15 microg/d) delivered by oral tablet or vaginal ring for 21 d in one of two treatment sequences. MAIN OUTCOME MEASURES Changes in plasma concentration or activity of 10 hemostatic variables and six estrogen-sensitive liver proteins between baseline and d 21 of treatment were the primary outcomes. RESULTS Prothrombin fragment 1 + 2 plasma level was unaffected by treatment or delivery route. Angiotensinogen (expressed as plasma level of angiotensin I) increased similarly with oral and vaginal delivery; mean (sd) increases were 2757 (1033) and 2864 (893) ng /ml, respectively (P = 0.0002). Alterations in other study variables, except total cholesterol, were similar with oral and vaginal administration. CONCLUSION Our results provide evidence that the customary effects of combined hormonal contraceptives on hemostatic variables and estrogen-sensitive liver proteins are largely related to EE and independent of delivery route during short-term treatment.
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Affiliation(s)
- Régine Sitruk-Ware
- Center for Biomedical Research, Population Council, New York, NY 10021, USA.
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Sitruk-Ware RL, Menard J, Rad M, Burggraaf J, de Kam ML, Tokay BA, Sivin I, Kluft C. Comparison of the impact of vaginal and oral administration of combined hormonal contraceptives on hepatic proteins sensitive to estrogen. Contraception 2007; 75:430-7. [PMID: 17519148 DOI: 10.1016/j.contraception.2007.01.027] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2006] [Revised: 11/23/2006] [Accepted: 01/23/2007] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We evaluated the effects of a new combined hormonal contraceptive vaginal ring (CVR) delivering the nonandrogenic progestin Nestorone (NES) and ethinyl estradiol (EE) on several key estrogen-sensitive hepatic proteins that may be markers for the risk of arterial or venous disease events and on blood pressure (BP). Because the pharmacologic androgenicity of the progestin in these formulations influences the hepatic impact of EE, we selected an oral contraceptive (OC) delivering the androgenic progestin levonorgestrel (LNG) and EE as the comparator. We also investigated the effect of delivery route, which is known to modify the hepatic effects of estradiol, but has not been widely studied with EE. STUDY METHODS Women, aged 18-34 years, with no contraindications to the use of combined OCs, were randomized to three cycles of treatment with a CVR delivering NES/EE (150/15 microg/day) or a combined OC providing LNG and EE (150/30 microg per tablet). Each cycle consisted of 21 days of active treatment, followed by 7 days without treatment. During the last weeks of the pretreatment and third treatment cycles, blood samples were obtained for determinations of plasma concentrations of angiotensinogen, an estrogen-sensitive hepatic protein, and serum concentrations of sex hormone-binding globulin (SHBG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG) and estrogen- and androgen-sensitive proteins. BP was also measured. RESULTS Of 47 women randomized, 45 completed the study (CVR: 23; OC: 22). Within-group comparisons over time by repeated-measure analysis of variance demonstrated statistically significant changes over time with both treatments for all hepatic proteins (p < .02) but not for TC. The within-group effects, presented as relative percent difference [95% confidence interval (CI)], were greatest for angiotensinogen [CVR: 227% (195-262%); OC: 251.3% (218-288%)] and SHBG [CVR: 306% (237-389%); OC: 55% (30-86)]. Both treatments were associated with small changes in systolic BP and diastolic BP (DBP), but only the within-group change in DBP for the OC group was statistically significant (p = .04). Between-treatment comparisons of third treatment cycle mean values were performed by analysis of covariance (baseline values as covariate). No statistically significant between-treatment differences were found for angiotensinogen, sensitive only to estrogen, or BP. Statistically significant treatment differences were found for all estrogen- and androgen-sensitive proteins (p < or = .002) but not for TC. When presented as relative percent difference between the effects of treatment (CVR-OC/OC; 95% CI of percent difference), the difference was largest for SHBG (159% [117-210%]); smaller relative percent differences were found for HDL-C [31.9% (18.5-46.8%)], LDL-C [23.6% (33.4% to -2.4%)] and TG [39.0% (14.0-69.4%)], but not TC. CONCLUSION Vaginal delivery of a combined hormonal contraceptive did not reduce the EE-associated changes in estrogen-sensitive hepatic proteins observed after use of a combined OC. Significant treatment differences between the NES/EE CVR and the LNG/EE OC were found for SHBG, HDL-C, LDL-C, and TG, proteins sensitive to androgen as well as estrogen. No treatment difference was observed for angiotensinogen, which is sensitive only to estrogen. The observed treatment differences were therefore most likely due to the difference in androgenicity between NES and LNG.
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MESH Headings
- Adolescent
- Adult
- Blood Proteins/drug effects
- Cholesterol/blood
- Cholesterol, HDL/blood
- Cholesterol, HDL/drug effects
- Cholesterol, LDL/blood
- Cholesterol, LDL/drug effects
- Contraceptive Agents, Female/administration & dosage
- Contraceptive Agents, Female/pharmacology
- Contraceptive Devices, Female
- Contraceptives, Oral, Combined/administration & dosage
- Contraceptives, Oral, Combined/pharmacology
- Ethinyl Estradiol/administration & dosage
- Ethinyl Estradiol/pharmacology
- Female
- Humans
- Levonorgestrel/administration & dosage
- Levonorgestrel/pharmacology
- Menstrual Cycle
- Norprogesterones/administration & dosage
- Norprogesterones/pharmacology
- Sex Hormone-Binding Globulin/drug effects
- Triglycerides/blood
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Deguchi H, Bouma BN, Middeldorp S, Lee YM, Griffin JH. Decreased plasma sensitivity to activated protein C by oral contraceptives is associated with decreases in plasma glucosylceramide. J Thromb Haemost 2005; 3:935-8. [PMID: 15869587 DOI: 10.1111/j.1538-7836.2005.01335.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Oral contraceptive (OC) use increases venous thrombosis (VTE) risk and causes activated protein C (APC) resistance. Plasma glucosylceramide (GlcCer) deficiency is associated with VTE and GlcCer functions as an APC anticoagulant cofactor. Because estradiol decreases GlcCer in cultured cells, we hypothesized OC use would decrease plasma GlcCer and contribute to APC resistance. In a pilot study, seven female adults alternatively took second and third generation OCs and plasma samples were analyzed for GlcCer using high performance liquid chromatography and for APC sensitivity using modified prothrombin time assays. Second and third generation OC usage decreased the APC sensitivity ratio by 8.1% +/- 4.7% (P = 0.004) and 11.7% +/- 8.2% (P = 0.013) and plasma GlcCer levels by 10.1% +/- 6.8% (P = 0.008) and 11.0% +/- 5.1% (P = 0.002), respectively. The plasma GlcCer level correlated with the sensitivity of plasma to APC (P = 0.017, r = 0.51, n = 21 plasma samples). Thus, both second and third generation OC usage decreased plasma GlcCer which could cause a reduction in the plasma sensitivity to APC/protein S, thereby potentially increasing VTE risk.
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Affiliation(s)
- H Deguchi
- The Scripps Research Institute, La Jolla, CA 92037, USA
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