Dokras Anuja, Playford Martin, Kris-Etherton Penny M, Kunselman Allen R, Stetter Christy M, Williams Nancy I, Gnatuk Carol L, Estes Stephanie J, Sarwer David B, Allison Kelly C, Coutifaris Christos, Mehta Nehal, Legro Richard S
The Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Section of Inflammation and Cardiometabolic Disease, National Heart, Lung and Blood Institute, Bethesda, MA, USA.
Clin Endocrinol (Oxf). 2017 May;86(5):739-746. doi: 10.1111/cen.13310. Epub 2017 Mar 9.
To study the effects of oral contraceptive pills (OCP), the first-line treatment for PCOS, on high-density lipoprotein cholesterol (HDL-C) function (reverse cholesterol efflux capacity) and lipoprotein particles measured using nuclear magnetic resonance spectroscopy in obese women.
Secondary analysis of a randomized controlled trial (OWL-PCOS) of OCP or Lifestyle (intensive Lifestyle modification) or Combined (OCP + Lifestyle) treatment groups for 16 weeks.
Eighty-seven overweight/obese women with PCOS at two academic centres.
Change in HDL-C efflux capacity and lipoprotein particles.
High-density lipoprotein cholesterol efflux capacity increased significantly at 16 weeks in the OCP group [0·11; 95% confidence interval (CI) 0·03, 0·18, P = 0·008] but not in the Lifestyle (P = 0·39) or Combined group (P = 0·18). After adjusting for HDL-C and TG levels, there was significant mean change in efflux in the Combined group (0·09; 95% CI 0·01, 0·15; P = 0·01). Change in HDL-C efflux correlated inversely with change in serum testosterone (r = -0·21; P = 0·05). In contrast, OCP use induced an atherogenic low-density lipoprotein cholesterol (LDL-C) profile with increase in small (P = 0·006) and large LDL-particles (P = 0·002). Change in small LDL-particles correlated with change in serum testosterone (r = -0·31, P = 0·009) and insulin sensitivity index (ISI; r = -0·31, P = 0·02). Both Lifestyle and Combined groups did not show significant changes in the atherogenic LDL particles.
Oral contraceptive pills use is associated with improved HDL-C function and a concomitant atherogenic LDL-C profile. Combination of a Lifestyle program with OCP use improved HDL-C function and mitigated adverse effects of OCP on lipoproteins. Our study provides evidence for use of OCP in overweight/obese women with PCOS when combined with Lifestyle changes.
研究多囊卵巢综合征（PCOS）的一线治疗药物口服避孕药（OCP）对肥胖女性高密度脂蛋白胆固醇（HDL-C）功能（逆向胆固醇流出能力）以及使用核磁共振波谱法测量的脂蛋白颗粒的影响。
对OCP组、生活方式干预组（强化生活方式改变）或联合治疗组（OCP + 生活方式干预）进行为期16周的随机对照试验（OWL-PCOS）的二次分析。
两个学术中心的87名超重/肥胖PCOS女性。
HDL-C流出能力和脂蛋白颗粒的变化。
OCP组在16周时HDL-C流出能力显著增加[0·11；95%置信区间（CI）0·03，0·18，P = 0·008]，而生活方式干预组（P = 0·39）和联合治疗组（P = 0·18）未增加。在调整HDL-C和甘油三酯（TG）水平后，联合治疗组的流出能力有显著的平均变化（0·09；95%CI 0·01，0·15；P = 0·01）。HDL-C流出能力的变化与血清睾酮的变化呈负相关（r = -0·21；P = 0·05）。相比之下，使用OCP会导致致动脉粥样硬化的低密度脂蛋白胆固醇（LDL-C）谱，小LDL颗粒（P = 0·006）和大LDL颗粒（P = 0·002）增加。小LDL颗粒的变化与血清睾酮的变化（r = -0·31，P = 0·009）和胰岛素敏感指数（ISI；r = -0·31，P = 0·02）相关。生活方式干预组和联合治疗组的致动脉粥样硬化LDL颗粒均未显示出显著变化。
使用口服避孕药与改善HDL-C功能以及伴随的致动脉粥样硬化LDL-C谱相关。生活方式干预方案与OCP联合使用可改善HDL-C功能，并减轻OCP对脂蛋白的不良影响。我们的研究为超重/肥胖PCOS女性在结合生活方式改变时使用OCP提供了证据。
