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Obstetrics & Gynecology 2008;111:857-864
© 2008 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Effects of Third-Generation Oral Contraceptives on High-Sensitivity C-reactive Protein and Homocysteine in Young Women

Sabina Cauci, PhD1, Manuela Di Santolo, MS1, Jennifer F. Culhane, PhD, MPH2, Giuliana Stel, MS3, Fabio Gonano, MD3 and Secondo Guaschino, MD4

From the 1Department of Biomedical Sciences and Technologies, School of Medicine, University of Udine, Udine, Italy; 2Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, Pennsylvania; 3Department of Experimental and Clinical Pathology and Medicine, School of Medicine, University of Udine, Udine, Italy; and 4Obstetric and Gynecologic Unit, Department of Reproductive and Development Sciences, IRCCS Burlo Garofolo Hospital, School of Medicine, University of Trieste, Trieste, Italy.

OBJECTIVE: To evaluate the effect of third-generation oral contraceptives on high-sensitivity C-reactive protein (CRP), homocysteine, and lipids levels in a population of young, fertile, nonobese women.

METHODS: Blood markers were evaluated in 277 healthy white women (mean age 23 years and mean body-mass index 21 kg/m2). Seventy-seven oral contraceptive users were compared with 200 non–oral contraceptive users. Progressive cutoffs of high-sensitivity CRP and homocysteine levels were examined.

RESULTS: Levels of high-sensitivity CRP posing a high risk of cardiovascular disease (3.0 to less than 10.0 mg/L) were found in 27.3% of oral contraceptive users and in 8.5% of non–oral contraceptive users (odds ratio 4.04; 95% confidence interval [CI] 1.99–8.18). Levels of high-sensitivity CRP at intermediate risk (1.0 to less than 3.0 mg/L) were found in 32.5% of oral contraceptive users and in 11.0% of non–oral contraceptive users (odds ratio 3.89; 95% CI 2.03–7.46). Notably, non–oral contraceptive users were 8.65 (95% CI 4.39–17.1) times as likely to demonstrate a protective level of high-sensitivity CRP (less than 0.5 mg/L) compared with oral contraceptive users. Oral contraceptive use increased serum triglycerides (P<.001) and total cholesterol P=.001); however, high-density lipoprotein, not low-density lipoprotein, contributed to this increase. A decreased ratio of low-density lipoprotein to high-density lipoprotein cholesterol was observed in oral contraceptive users compared with nonusers (P=.016). Oral contraceptive use did not affect homocysteine levels.

CONCLUSION: Third-generation oral contraceptive use increases low-grade inflammatory status measured by high-sensitivity CRP concentrations. Alteration of inflammatory status in oral contraceptive users could affect the risk of venous thromboembolism, cardiovascular disease, and other oral contraceptive-associated adverse conditions in young women.

LEVEL OF EVIDENCE: II






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