Morin-Papunen Laure, Martikainen Hannu, McCarthy Mark I, Franks Stephen, Sovio Ulla, Hartikainen Anna-Liisa, Ruokonen Aimo, Leinonen Maija, Laitinen Jaana, Järvelin Marjo-Riitta, Pouta Anneli
Department of Obstetrics and Gynecology, University Hospital of Oulu, Oulu, Finland.
Am J Obstet Gynecol. 2008 Nov;199(5):529.e1-529.e10. doi: 10.1016/j.ajog.2008.04.013. Epub 2008 Jun 4.
We compared the metabolic and cardiovascular parameters of a reference group of women with those of women who used 2 contraceptive regimes that are used worldwide: the levonorgestrel-releasing intrauterine device and oral contraceptives.
We investigated a cohort of 2814 women at age 31 years from the general population-based Northern Finland Birth Cohort who were born in 1966. Women were classified as oral contraceptive users (n = 687 women), levonorgestrel-releasing intrauterine device users (n = 168 women), or no use of hormonal contraception (reference group; n = 1959 women). The analyses were adjusted for body mass index, current alcohol use, household income, and area of residence.
Compared with the reference group, oral contraceptive users had higher systolic and diastolic blood pressure, raised levels of inflammatory indices (C-reactive protein), and impaired insulin sensitivity. Levonorgestrel-releasing intrauterine device users displayed a lower high-density lipoprotein and total cholesterol, but a similar cholesterol/ high-density lipoprotein ratio, and higher leukocyte count compared with the reference group. Oral contraception users were insulin-resistant compared with levonorgestrel-releasing intrauterine device users with higher blood pressure, raised lipid levels (such as total cholesterol and triglycerides) and insulin levels, and lower homeostasis model assessment and insulin sensitivity, despite smaller waist and lower waist-hip ratio.
Oral contraception usage was associated with adverse findings in several metabolic, cardiovascular, and inflammatory parameters, which is consistent with an increased future risk of cardiovascular and metabolic disease. These findings should invite more criticism of recent trends that encourage the prescription of oral contraceptives for years during reproductive life and especially in premenopausal women. In contrast, levonorgestrel-releasing intrauterine device or progestin-only pills may offer long-term health benefits over oral contraceptives and should be preferred to oral contraceptives for women in their forties and/or with metabolic risk factors for cardiovascular diseases and type 2 diabetes mellitus.
我们将一组女性的代谢和心血管参数与使用全球范围内两种避孕方法的女性进行了比较，这两种方法分别是左炔诺孕酮宫内节育器和口服避孕药。
我们调查了来自以人群为基础的芬兰北部出生队列中2814名31岁的女性，她们出生于1966年。女性被分为口服避孕药使用者（n = 687名女性）、左炔诺孕酮宫内节育器使用者（n = 168名女性）或未使用激素避孕者（对照组；n = 1959名女性）。分析对体重指数、当前饮酒情况、家庭收入和居住地区进行了校正。
与对照组相比，口服避孕药使用者的收缩压和舒张压更高，炎症指标（C反应蛋白）水平升高，胰岛素敏感性受损。与对照组相比，左炔诺孕酮宫内节育器使用者的高密度脂蛋白和总胆固醇较低，但胆固醇/高密度脂蛋白比值相似，白细胞计数较高。与左炔诺孕酮宫内节育器使用者相比，口服避孕药使用者存在胰岛素抵抗，血压更高，血脂水平（如总胆固醇和甘油三酯）和胰岛素水平升高，稳态模型评估和胰岛素敏感性更低，尽管腰围更小且腰臀比更低。
口服避孕药的使用与多个代谢、心血管和炎症参数的不良结果相关，这与未来心血管和代谢疾病风险增加一致。这些发现应引发对近期趋势的更多批评，即鼓励在生育期尤其是绝经前女性中多年开具口服避孕药。相比之下，左炔诺孕酮宫内节育器或仅含孕激素的避孕药可能比口服避孕药具有长期健康益处，对于四十多岁和/或有心血管疾病和2型糖尿病代谢危险因素的女性，应优先于口服避孕药使用。
