Safety evaluation of modern oral contraceptives. Effects on lipoprotein and carbohydrate metabolism
Crook, D.; Godsland, I.
Contraception 57(3): 189-201
1998
ISSN/ISBN: 0010-7824 PMID: 9617535 DOI: 10.1016/s0010-7824(98)00018-3Document Number: 275709
Depending on their formulation, modern low-dose oral contraceptives (OCs) affect systems such as hemostasis, lipoprotein metabolism, and glucose and insulin metabolism. This paper reviews the research literature on these effects and assesses their clinical implications for arterial disease. At greatest risk are women with high plasma levels of the potentially atherogenic lipoproteins (low, intermediate, and very low density lipoproteins) and low plasma levels of high density lipoprotein. Recent studies suggest that the quality of lipoproteins, especially their ability to resist oxidative modification, may be as important as their plasma levels. At present, there is no justification for widespread metabolic screening as a strategy to further improve OC safety. Recent developments in atherosclerosis research support the introduction of progestogens such as desogestrel that allow the estrogenic increase in high density lipoprotein levels to persist and that may cause less of an elevation in plasma insulin responses to glucose. The predicted benefit of these formulations in terms of arterial disease is difficult to demonstrate in an epidemiologic setting, however, because of the rarity of the disease in young women.
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