Plasma lipids and desogestrel and ethinyl estradiol: a meta-analysis

To review the literature to determine the magnitude of the effect of 150 micrograms desogestrel-30 micrograms ethinyl E2, an oral contraceptive (OC) formulation, on plasma lipid concentrations in healthy women using meta-analysis techniques.

All English-language published reports (1981 to 1991) on lipid parameters in women taking 150 micrograms desogestrel and 30 micrograms ethinyl E2 for up to 6 months obtained via an Embase database search and via a subsequent review of the reference lists.

Of 98 articles, 18 met eligibility criteria and were included in the meta-analysis.

Data on total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides were extracted. The change in each parameter from baseline to cycle 6 was estimated as a weighted mean of changes reported in each study; a standard error of the estimate was calculated. This procedure was validated by goodness-of-fit tests.

The following statistically significant changes from baseline to cycle 6 were estimated (mean +/- SE): HDL-C: 0.15 +/- 0.02 mmol/L (5.80 +/- 0.62 mg/dL); triglycerides: 0.28 +/- 0.03 mmol/L (24.49 +/- 2.59 mg/dL); and LDL: - 0.12 +/- 0.04 mmol/L (-4.53 +/- 1.55 mg/dL). There was a nonsignificant trend toward an increase in total cholesterol.

When given in combination with 30 micrograms ethinyl E2, desogestrel increased HDL-C and triglycerides and decreased LDL-C. The positive impact on HDL-C and LDL-C suggests that a potential cardioprotective benefit (rather than an atherosclerosis risk) may occur with prolonged use of such an OC, but this hypothesis will be difficult to prove.