Crook D, Godsland I F, Wynn V
Cavendish Clinic, London, England.
Am J Obstet Gynecol. 1988 Jun;158(6 Pt 2):1612-20. doi: 10.1016/0002-9378(88)90199-8.
Widespread use of oral contraceptive formulations by women throughout their reproductive life has given rise to concerns about the effects of oral contraceptives on risk factors for coronary heart disease. Oral contraceptive-induced changes in both carbohydrate and lipoprotein risk factors may contribute to an increased risk of coronary heart disease. Carbohydrate and lipoprotein risk factors for coronary heart disease are reviewed, and oral contraceptive-induced changes in carbohydrate and lipoprotein metabolism, which may lead to altered risk status for coronary heart disease, are discussed. The importance of methodology in evaluating the results of studies assessing such oral contraceptive-induced changes is stressed. The role of progestins in influencing coronary heart disease risk factors is surveyed, and differences among progestins commonly used in oral contraceptive formulations are discussed. In addition, the effect of various combination oral contraceptives on risk factor status is outlined. Finally, the implications of available evidence for the selection of progestins for oral contraceptive formulations of the future are discussed. Current data indicate that medium- and low-fixed-dose oral contraceptive formulations containing estrogen/norethindrone acetate have less metabolic impact than do comparable levonorgestrel-containing formulations, including multiphasic formulations. Triphasic formulations may have less effect on coronary heart disease risk factors, although data are not yet conclusive. Novel progestins such as desogestrel may also have lesser effects on metabolic functions, but the reduced androgenicity of such compounds may expose women to an increased risk of estrogen-induced hypertriglyceridemia.
在整个育龄期，女性广泛使用口服避孕药引发了人们对口服避孕药对冠心病危险因素影响的担忧。口服避孕药引起的碳水化合物和脂蛋白危险因素的变化可能会增加冠心病的风险。本文回顾了冠心病的碳水化合物和脂蛋白危险因素，并讨论了口服避孕药引起的碳水化合物和脂蛋白代谢变化，这些变化可能导致冠心病风险状况的改变。强调了评估此类口服避孕药引起的变化的研究结果时方法学的重要性。综述了孕激素对冠心病危险因素的影响，并讨论了口服避孕药制剂中常用孕激素之间的差异。此外，概述了各种复方口服避孕药对危险因素状况的影响。最后，讨论了现有证据对未来口服避孕药制剂中孕激素选择的意义。目前的数据表明，含有雌激素/醋酸炔诺酮的中低固定剂量口服避孕药制剂比含有左炔诺孕酮的类似制剂，包括多相制剂，具有更小的代谢影响。三相制剂对冠心病危险因素的影响可能较小，尽管数据尚无定论。新型孕激素如去氧孕烯对代谢功能的影响可能也较小，但此类化合物雄激素活性的降低可能使女性面临雌激素诱导的高甘油三酯血症风险增加。
