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  • Title: Atherosclerotic risk factors in cardiovascular disease.
    Author: LaRosa JC.
    Journal: J Reprod Med; 1986 Sep; 31(9 Suppl):906-12. PubMed ID: 3772910.
    Abstract:
    Atherosclerotic risk factors in cardiovascular disease include several that may be modified by changes in life-style or with drugs. Oral contraceptive agents may affect lipoproteins and glucose tolerance in particular. This paper reviews the relationship between lipoproteins, abnormal glucose tolerance and atherosclerosis and the implications that these relationships have for all oral contraceptive users. This review of atherosclerotic risk factors in cardiovascular disease concentrates on those aspects of lipid and carbohydrate metabolism that may be associated with atherogenesis and that may be altered by ingestion of oral contraceptive (OC) agents. Atherogenesis is facilitated by 1 or more of at least 3 conditions: elevated low-density lipoprotein (LDL) levels, elevated intermediate-density lipoprotein (IDL) levels (which are remnants of very-low-density lipoprotein level catabolism), and increased quantities of the breakdown products of chylomicron metabolism (chylomicron remnants) and decreased high-density lipoprotein (HDL) levels. Over the year, considerable evidence has linked atherosclerosis, particularly that occurring in the coronary vessels, to elevated levels of both dietary and blood cholesterol. Since LDL is the major carrier of cholesterol in the plasma, it comes as no surprise that there is a strong relationship between elevated plasma LDL levels and coronary vascular disease. Low levels of HDL also are predictive of coronary vascular disease. Moreover, low HDL levels are increasingly associated with atherosclerosis in the cerebral and peripheral blood vessels, while total and LDL cholesterol levels are not as predictive of such disease. It has been reasonably well established that lipid abnormalities are associated with atherogenesis in the laboratory and with clinical vascular disease in patients. It has been more difficult to demonstrate that atherosclerosis can be prevented or reversed by treatment of such disorders. Yet, considerable evidence supports that point of view. Many questions remain concerning the relationship of atherogenesis and abnormalities of lipoprotein metabolism. The relationship between diabetes and atherosclerosis is even less well understood. There is little question that diabetics are at increased risk of developing atherosclerosis. In fact, atherosclerosis may be more prominent in diabetic women. Regarding OCs, several general points need to be made before discussing the effects of OCs on atherosclerotic risk factors: OCs may have effects on other metabolic parameters that have not been identified as prominent risk facts in atherogenesis; in some cases OCs appear to enhance the effects of other risk factors in ways that are not totally understood; and OCs may profoundly affect the metabolism of lipoproteins and glucose in ways that enhance atherogenesis. Women who use OCs must be carefully counseled about the interplay of such agents and other atherosclerotic risk factors. The decision to place a woman with 1 or more prominent atherosclerotic risk factors on OCs should be a careful one. Risk factors, particularly levels of total and HDL cholesterol, blood glucose, blood pressure, and smoking status, should be ascertained before prescribing OCs, particularly in women with family histories of heart disease.
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