Impact of Hormonal Contraception and Weight Loss on HDL-C 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 HDL-C function (reverse cholesterol efflux capacity) and lipoprotein particles measured by NMR spectroscopy.

Design

Secondary analysis of a randomized controlled trial (OWL-PCOS) of OCP or Lifestyle (intensive lifestyle modification) or Combined (OCP+Lifestyle) treatment for 16 weeks.

Patients

87 overweight/obese women with PCOS at two academic centers.

Measurements

Change in HDL-C efflux capacity and lipoprotein particles.

Results

HDL-C efflux capacity increased significantly at 16 weeks in the OCP group (0.11; 95% 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 (r_s = -0.21; p=0.05). In contrast, OCP use induced an atherogenic 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 (r_s = -0.31, p=0.009) and insulin sensitivity index (r_s = -0.31, p=0.02). Both Lifestyle and Combined groups did not show significant changes in the atherogenic LDL-particles.

Conclusions

OCP 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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