Impact of hormonal contraception and weight loss on high-density lipoprotein cholesterol efflux and lipoprotein particles in women with polycystic ovary syndrome

Anuja Dokras, Martin Playford, Penny Margaret Kris-Etherton, Allen Kunselman, Christy M. Stetter, Nancy Williams, Carol Gnatuk, Stephanie Estes, David B. Sarwer, Kelly C. Allison, Christos Coutifaris, Nehal Mehta, Richard Legro

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objective: 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. Design: 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. Patients: Eighty-seven overweight/obese women with PCOS at two academic centres. Measurements: Change in HDL-C efflux capacity and lipoprotein particles. Results: 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 (rs = −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 (rs = −0·31, P = 0·009) and insulin sensitivity index (ISI; rs = −0·31, P = 0·02). Both Lifestyle and Combined groups did not show significant changes in the atherogenic LDL particles. Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)739-746
Number of pages8
JournalClinical Endocrinology
Volume86
Issue number5
DOIs
StatePublished - May 1 2017

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Polycystic Ovary Syndrome
Oral Contraceptives
Contraception
HDL Cholesterol
Lipoproteins
Weight Loss
Life Style
LDL Cholesterol
Testosterone
Confidence Intervals
Contraceptives, Oral, Combined
Lipoprotein(a)
Serum
Insulin Resistance
Magnetic Resonance Spectroscopy
Randomized Controlled Trials
Cholesterol
Therapeutics

All Science Journal Classification (ASJC) codes

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

@article{1e6c96da4b5248339ab6a924fd80b316,
title = "Impact of hormonal contraception and weight loss on high-density lipoprotein cholesterol efflux and lipoprotein particles in women with polycystic ovary syndrome",
abstract = "Objective: 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. Design: 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. Patients: Eighty-seven overweight/obese women with PCOS at two academic centres. Measurements: Change in HDL-C efflux capacity and lipoprotein particles. Results: 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 (rs = −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 (rs = −0·31, P = 0·009) and insulin sensitivity index (ISI; rs = −0·31, P = 0·02). Both Lifestyle and Combined groups did not show significant changes in the atherogenic LDL particles. Conclusions: 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.",
author = "Anuja Dokras and Martin Playford and Kris-Etherton, {Penny Margaret} and Allen Kunselman and Stetter, {Christy M.} and Nancy Williams and Carol Gnatuk and Stephanie Estes and Sarwer, {David B.} and Allison, {Kelly C.} and Christos Coutifaris and Nehal Mehta and Richard Legro",
year = "2017",
month = "5",
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doi = "10.1111/cen.13310",
language = "English (US)",
volume = "86",
pages = "739--746",
journal = "Clinical Endocrinology",
issn = "0300-0664",
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Impact of hormonal contraception and weight loss on high-density lipoprotein cholesterol efflux and lipoprotein particles in women with polycystic ovary syndrome. / Dokras, Anuja; Playford, Martin; Kris-Etherton, Penny Margaret; Kunselman, Allen; Stetter, Christy M.; Williams, Nancy; Gnatuk, Carol; Estes, Stephanie; Sarwer, David B.; Allison, Kelly C.; Coutifaris, Christos; Mehta, Nehal; Legro, Richard.

In: Clinical Endocrinology, Vol. 86, No. 5, 01.05.2017, p. 739-746.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Impact of hormonal contraception and weight loss on high-density lipoprotein cholesterol efflux and lipoprotein particles in women with polycystic ovary syndrome

AU - Dokras, Anuja

AU - Playford, Martin

AU - Kris-Etherton, Penny Margaret

AU - Kunselman, Allen

AU - Stetter, Christy M.

AU - Williams, Nancy

AU - Gnatuk, Carol

AU - Estes, Stephanie

AU - Sarwer, David B.

AU - Allison, Kelly C.

AU - Coutifaris, Christos

AU - Mehta, Nehal

AU - Legro, Richard

PY - 2017/5/1

Y1 - 2017/5/1

N2 - Objective: 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. Design: 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. Patients: Eighty-seven overweight/obese women with PCOS at two academic centres. Measurements: Change in HDL-C efflux capacity and lipoprotein particles. Results: 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 (rs = −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 (rs = −0·31, P = 0·009) and insulin sensitivity index (ISI; rs = −0·31, P = 0·02). Both Lifestyle and Combined groups did not show significant changes in the atherogenic LDL particles. Conclusions: 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.

AB - Objective: 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. Design: 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. Patients: Eighty-seven overweight/obese women with PCOS at two academic centres. Measurements: Change in HDL-C efflux capacity and lipoprotein particles. Results: 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 (rs = −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 (rs = −0·31, P = 0·009) and insulin sensitivity index (ISI; rs = −0·31, P = 0·02). Both Lifestyle and Combined groups did not show significant changes in the atherogenic LDL particles. Conclusions: 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.

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