Effect of second and third generation oral contraceptives on lipid metabolism in the absence or presence of the factor V Leiden mutation.
OBJECTIVE
The effect of a second and third generation oral contraceptive and of the progestagens used in these pills on lipid metabolism was studied in the absence or presence of the factor V Leiden mutation.


METHODS
A single centre, double blind randomized trial.


METHODS
University Medical Centre.


METHODS
A total of 51 women without and 35 women with the factor V Leiden mutation.


METHODS
A second generation (30 microg ethinylestradiol/150 microg levonorgestrel) or a third generation (30 microg ethinylestradiol/l 50 microg desogestrel) oral contraceptive. After two cycles of use and a wash-out period of two cycles, the participants received the corresponding progestagen-only preparation containing 150 microg levonorgestrel or 150 microg desogestrel.


METHODS
Mean difference in changes between the treatment groups on total cholesterol, HDL, LDL, triglycerides and total/HDL cholesterol ratio.


RESULTS
Compared with levonorgestrel, desogestrel-containing oral contraceptives caused in women without the factor V Leiden mutation significant changes in HDL (0.43; 95% confidence interval [CI] 0.25-0.61), LDL (-0.55; 95% CI -0.90 to -0.20), triglycerides (0.19; 95% CI 0.06-0.32) and total/ HDL cholesterol ratio (-0.87; 95% CI -1.21 to -0.53). When the progestagen-only preparations were used, differential changes were found for HDL (0.16; 95% CI 0.03-0.29), LDL (-0.31; 95% CI - 0.56 to -0.05) and total/HDL cholesterol ratio (-0.55; 95% CI -0.84 to -0.26). Desogestrel-only caused changes opposite to those of desogestrel-containing oral contraceptives. For cholesterol and triglycerides, this effect was also found for levonorgestrel-only in comparison with levonorgestrel-combined oral contraceptives. Levonorgestrel appeared to induce the effect on HDL. Almost all results were similar for women with the factor V Leiden mutation.


CONCLUSIONS
It appears that desogestrel counteracts the effects of oestrogens to a lesser extent than levonorgestrel. Desogestrel-containing oral contraceptives have therefore a more favourable influence on cholesterol metabolism in comparison with levonorgestrel-containing oral contraceptives.
Kemmeren
J M
JM
Julius Center for General Practice and Patient Oriented Research, University Medical Center Utrecht, The Netherlands.
Algra
A
A
Grobbee
D E
DE
D000293:Adolescent; D000328:Adult; D002784:Cholesterol / Q000097:blood; D003280:Contraceptives, Oral, Synthetic / Q000494:pharmacology*; D017135:Desogestrel / Q000494:pharmacology; D004311:Double-Blind Method; D004997:Ethinyl Estradiol / Q000494:pharmacology; D005165:Factor V / Q000187:drug effects* / Q000235:genetics*; D005260:Female; D006801:Humans; D016912:Levonorgestrel / Q000494:pharmacology; D050356:Lipid Metabolism; D008055:Lipids / Q000235:genetics*; D008075:Lipoproteins, HDL / Q000097:blood / Q000187:drug effects; D017354:Point Mutation / Q000187:drug effects* / Q000235:genetics*; D045167:Progesterone Congeners / Q000494:pharmacology*; D014280:Triglycerides / Q000097:blood
D003280:Contraceptives, Oral, Synthetic; D008055:Lipids; D008075:Lipoproteins, HDL; D045167:Progesterone Congeners; D014280:Triglycerides; C095381:factor V Leiden; D004997:Ethinyl Estradiol; D016912:Levonorgestrel; D017135:Desogestrel; D005165:Factor V; D002784:Cholesterol