Dasgupta Subhankar, Mondal Joyeeta, Goswami Barnali, Dasgupta Jija
Department of Obstetrics and Gynecology, Rampurhat Government Medical College and Hospital, Birbhum, India.
Diamond Harbour Government Medical College and Hospital, Diamond Harbour, India.
Obstet Gynecol Sci. 2023 Nov;66(6):572-583. doi: 10.5468/ogs.23142. Epub 2023 Nov 1.
Regular users of hormonal contraceptive pills show marked heterogeneity in metabolic effects with variations in compositions. This might be due to choice of outcome variables for comparison. Total cholesterol-high-density lipoprotein ratio (TC/HDL) discordance with low-density lipoprotein (LDL-C) has now become an established marker of future risk for atherosclerotic cardiovascular disease and stable to variations in user.
The present study was a randomized controlled trial to compare prevalence of TC/HDL and LDL discordance among non-obese women with polycystic ovarian syndrome (PCOS) treated with hormonal pills. Women were randomized into three arms, two arms received ultra-low dose pills (Ethinylestradiol [EE] 20 μg with drosperinone 3 mg or EE 15 μg with gestodene 60 μg) and one arm received low dose pill (EE 30 μg with desogestrel 150 μg). The role of baseline participant features and pill composition on discordance was determined.
Discordance was observed in more than a quarter of the participants before intervention. After 1 year of treatment, less than a fifth of the participants were discordant. Ultralow-dose pill users had lower discordance, LDL, and TC than low-dose pill users after 1 year of treatment. The random forest, a non-linear classifier, showed the highest accuracy in predicting discordance. The baseline Parameters with the maximal impact on the occurrence of discordance were triglyceride, homeostatic model assessment for insulin resistance, body mass index, and high density lipoprotein.
Non-obese PCOS women on ultra-low dose pill have a lower risk of acquiring future atherosclerotic cardiovascular disease.
激素避孕药的常规使用者在代谢效应方面表现出显著的异质性，这与药物成分的变化有关。这可能是由于用于比较的结果变量的选择。总胆固醇与高密度脂蛋白比值（TC/HDL）与低密度脂蛋白（LDL-C）不一致，现已成为未来动脉粥样硬化性心血管疾病风险的既定标志物，并且对使用者的变化具有稳定性。
本研究是一项随机对照试验，旨在比较接受激素避孕药治疗的非肥胖多囊卵巢综合征（PCOS）女性中TC/HDL和LDL不一致的患病率。女性被随机分为三组，两组接受超低剂量避孕药（炔雌醇[EE]20μg与屈螺酮3mg或EE 15μg与孕二烯酮60μg），一组接受低剂量避孕药（EE 30μg与去氧孕烯150μg）。确定了基线参与者特征和避孕药成分对不一致性的作用。
干预前超过四分之一的参与者出现不一致情况。治疗1年后，不到五分之一的参与者出现不一致。治疗1年后，超低剂量避孕药使用者的不一致性、LDL和TC低于低剂量避孕药使用者。随机森林，一种非线性分类器，在预测不一致性方面显示出最高的准确性。对不一致性发生影响最大的基线参数是甘油三酯、胰岛素抵抗稳态模型评估、体重指数和高密度脂蛋白。
服用超低剂量避孕药的非肥胖PCOS女性患未来动脉粥样硬化性心血管疾病的风险较低。
