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.
  
  
  METHODS
  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.
  
  
  METHODS
  Eighty-seven overweight/obese women with PCOS at two academic centres.
  
  
  METHODS
  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.
authors.affiliation: The Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Anuja
authors.identifier: http://orcid.org/0000-0002-1085-3969
authors.initials: A
authors.lastname: Dokras
authors.affiliation: Section of Inflammation and Cardiometabolic Disease, National Heart, Lung and Blood Institute, Bethesda, MA, USA.
authors.forename: Martin
authors.initials: M
authors.lastname: Playford
authors.affiliation: Department of Nutritional Sciences, Penn State College of Health and Human Development, University Park, Philadelphia, PA, USA.
authors.forename: Penny M
authors.initials: PM
authors.lastname: Kris-Etherton
authors.affiliation: Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.
authors.forename: Allen R
authors.initials: AR
authors.lastname: Kunselman
authors.affiliation: Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.
authors.forename: Christy M
authors.initials: CM
authors.lastname: Stetter
authors.affiliation: Department of Kinesiology, Penn State College of Health and Human Development, University Park, Philadelphia, PA, USA.
authors.forename: Nancy I
authors.initials: NI
authors.lastname: Williams
authors.affiliation: Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, PA, USA.
authors.forename: Carol L
authors.initials: CL
authors.lastname: Gnatuk
authors.affiliation: Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, PA, USA.
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Estes
authors.affiliation: Department of Psychiatry, Temple University, Philadelphia, PA, USA.|Department of Social and Behavioral Science, Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, PA, USA.
authors.forename: David B
authors.initials: DB
authors.lastname: Sarwer
authors.affiliation: Department of Psychiatry, Temple University, Philadelphia, PA, USA.
authors.forename: Kelly C
authors.initials: KC
authors.lastname: Allison
authors.affiliation: The Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Christos
authors.initials: C
authors.lastname: Coutifaris
authors.affiliation: Section of Inflammation and Cardiometabolic Disease, National Heart, Lung and Blood Institute, Bethesda, MA, USA.
authors.forename: Nehal
authors.initials: N
authors.lastname: Mehta
authors.affiliation: Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.|Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, PA, USA.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Legro
mesh_terms: D000328:Adult; D008076:Cholesterol, HDL / Q000097:blood* / Q000187:drug effects; D008078:Cholesterol, LDL / Q000097:blood* / Q000187:drug effects; D003276:Contraceptives, Oral / Q000494:pharmacology*; D005260:Female; D006801:Humans; D009765:Obesity / Q000097:blood / Q000188:drug therapy / Q000628:therapy; D050177:Overweight / Q000097:blood* / Q000188:drug therapy / Q000628:therapy*; D011085:Polycystic Ovary Syndrome / Q000097:blood* / Q000188:drug therapy / Q000628:therapy*; D040242:Risk Reduction Behavior; D015431:Weight Loss; D055815:Young Adult
chemical_list: D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D003276:Contraceptives, Oral