Alterations of lipid metabolism by contraceptive steroids

Abstract

Estrogen administration leads to increased fasting serum triglyceride concentrations which appears to be due primarily to increased hepatic production of triglycerides. These changes are favored by the increase in circulating insulin and growth hormone concentrations and the blunting of aminogenie glucagon secretion often observed in users of birth control pills. Nortestosterone derivatives (but not 17α-acetoxyprogesterone derivatives) counteract the hypertriglyceridemic effect of estrogens. A small group of patients react dramatically to estrogens with the development of massive hypertriglyceridemia. This latter group of patients appears to be particularly susceptible to pancreatitis and to electrocar-diographic changes compatible with coronary artery disease.The changes in serum cholesterol concentrations induced by individual contraceptive steroids appear to be opposite in direction from the changes observed in triglyceride concentrations. When changes in circulating cholesterol concentrations occur, they appear to be much smaller than those observed with the triglycerides. Estrogen administration produces changes in cholesterol and bile metabolism which favors gall stone formation. It is significant that an increased incidence of cholelithiasis has been observed in users of contraceptive steroids.Whether the modest changes in cholesterol and triglyceride metabolism have any effect on the development of atherosclerosis and coronary heart disease remains to be determined.