Lipid oral contraceptive effects

The 1990 report of the International Consensus Development Meeting stated the following regarding the effects of oral contraceptives on carbohydrate and lipid metabolism (19) All currently used oral contraceptives... 

Lipid changes seen with the most widely used combined oral contraceptives comprise an increase in low density lipoprotein and reductions in high density lipoprotein and cholesterol. The third-generation products have these effects to a much smaller extent, leading to claims that they would be less likely to have long-term adverse cardiovascular effects related to atherosclerosis. However, such a claim reflects an all too readily adopted belief that the lipid changes produced by the more traditional combined oral contraceptives are in this respect capable of causing this type of (primarily arterial) cardiovascular disease. This is of itself far from certain. 

Simon D, Senan C, Gamier P, Saint-Paul M, Garat E, Thibult N, Papoz L. Effects of oral contraceptives on carbohydrate and lipid metabolisms in a healthy population the Telecom study. Am J Obstet Gynecol 1990 163(1 Pt 2) 382-7. 

M4. Maniego-Bautista, L. P., and Bazzano, G., Effects of oral contraceptives on serum lipid and folate levels. /. Lab. Clin. Med. 74, 988 (1969). 

Oral contraceptive preparations based upon EE and a progestagen derived from progesterone produce the anticipated effects upon lipids Table... 

In trying to assess the pathological significance of the foregoing effects of oral contraceptives upon plasma lipids, it should be borne in mind that TG levels are markedly affected by such factors as dietary intake, age, obesity, preclinical diabetes and race. 

Table 5.7 effects of oral contraceptives upon plasma lipids... 

The adverse effects of isotretinoin and combined oral contraceptives on plasma lipids may be additive. A case-control study found that women who had hypertriglyceridaemia and/or hypercholesterolaemia while taking isotretinoin were 2 to 12 times as likely to be also taking an oral contraceptive. ... 

Atorva tatin and ro uva tatin may modestly increase the plasma levels of combined oral contraceptives. Rosuvastatin pharmacokinetics and lipid-lowering effects were unaffected by an oral contraceptive containing ethinylestradiol and norgestimate. The pharmacokinetics of a single dose of pravastatin were also unaffected by combined oral contraceptives. However, norethisterone abolished the beneficial effects of atorvastatin and/or estradiol on the lipid profile. 

The cardiovascular effects reported do not appear to be attributable to any effect of smoking on the metabolism of contraceptives steroids (see below). Rather, the adverse effects of combined oral contraceptives on cardiovascular risk factors, such as plasma lipids and coagulation parameters, appear to be accentuated by smoking. 

A comparative study in men, women, and women taking combined oral contraceptives found that the clearance of clofibrate was increased by 48% in those taking combined oral contraceptives, apparently due to an increase in clofibrate glucuronidation. Another study found that combined oral contraceptives increased the excretion of clofibric acid glucuro-nide (the pharmacologically active form of clofibrate) by 25%. None of these studies addressed the question of whether concurrent use significantly reduces clofibrate efficacy, but it would seem prudent to monitor for increases in blood lipid levels. It should be noted that combined oral contraceptives themselves can have various adverse effects on lipid levels, and these may impair the effects of treatment. 

Stovein, V. and MacDonald, I. Some effects of diet with oral contraceptives on carbohydrate lipid metabolism in the baboon. Proc. Nutr. Soc. 32 34A. 

With regard to serum lipids and oral contraceptives much work has been devoted to finding out which hormones and which combinations are least prone to induce changes. Briggs (114 ) has provided data on the combination ethinyloestradiol (30 mg) and norgestrel (150 )ig) which seems to have a minimum effect on cholesterol and triglycerides. 

Wu FC, Balasubramanian R, Mulders TM, Coelingh-Bennink HJ. Oral progestogen combined with testosterone as a potential male contraceptive additive effects between desogestrel and testosterone enanthate in suppression of spermatogenesis, pituitary-testicular axis, and lipid metabolism. J Clin Endocrinol Metab 1999 84(l) 112-22. 

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