The effects of different formulations of oral contraceptive agents on lipid and carbohydrate metabolism

Article Abstract:

Women who use oral contraceptives undergo considerable changes in their metabolic patterns, and these patterns may resemble those seen in individuals who are at increased risk for coronary heart disease (CHD, blockage of the arteries which bring blood to the heart itself). This study investigated the changes in the blood levels of specific lipids and carbohydrates that occur while on various oral contraceptives. These lipid and carbohydrate levels have proven to be markers of risk for heart disease. Blood levels of cholesterol, triglycerides, and other compounds related to CHD risk were measured for groups of patients taking different contraceptives. Glucose tolerance, an index of insulin production, was also used to analyze shifts in carbohydrate metabolism while on the various contraceptive agents. The studies were carried out on a group of 1,060 women who took one of nine different formulations of oral contraceptive for a period of at least three months. These results were compared with a group of 418 women who did not use oral contraception (control group). Women taking combination oral contraceptives (containing progesterone and estrogen) did not demonstrate changes in total cholesterol level, but the level of triglycerides was raised, which is thought to increase risk of heart disease. The glucose level in patients taking a combination contraceptive was adversely effected, as was the level of insulin secretion. Patients taking a pill containing only progestin (a progesterone-like compound) showed no such effect on carbohydrate metabolism. The composition of the specific oral contraceptive used can have a significant and adverse effect on both lipid and carbohydrate metabolism. In general, combination medications with low levels of norethindrone (progestin) or desogestrel (a progestin, not yet approved in the United States), or progestin-only oral contraceptives, were found to cause the smallest adverse effects. This study shows that the progestins currently in use can have a serious effect on metabolism when combined with estrogen. However, a change in the specific progestin, and/or a decrease in the dosage, can produce a substantial decrease in the risk of heart disease in women who use oral contraceptives. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Lipid metabolism, Oral contraceptives, Carbohydrate metabolism, Progestational hormones, Norethindrone

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Passive smoking, coronary heart disease, and meta-analysis

Article Abstract:

It is still not clear whether passive smoking increases the risk of coronary heart disease in non-smokers. A 1999 study found an increased risk of coronary heart disease of 25% in non-smokers exposed to cigarette smoke. This is a much bigger risk than expected, since smokers have a 75% increased risk of coronary heart disease. The figure may be inaccurate because the authors of the study used a technique called meta-analysis to evaluate 18 epidemiologic studies of passive smoking. Meta-analysis involves combining the results of several studies to identify trends in the data. But the technique has inherent weaknesses.

Editorial, Evaluation, Meta-analysis, Passive smoking

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Low HDL cholesterol levels

Article Abstract:

The clinical problem of low high-density lipoprotein (HDL) cholesterol level, which causes a high risk of coronary heart disease and death from cardiovascular illnesses, is highlighted. Various strategies and lifestyle changes are recommended for increasing HDL cholesterol levels.

New England States, Cholesterol, HDL, HDL cholesterol lipoproteins, New England

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