In girls with polycystic ovary syndrome (PCOS), treatment with oral contraceptives raised the levels of inflammatory markers that may be associated with a higher risk of cardiovascular disease. The findings from a pilot study are being presented Monday, June 4, at The Endocrine Society’s 89th Annual Meeting in Toronto.

Few studies have been done in teenage patients with PCOS to evaluate the pill’s effect on inflammatory markers called cytokines, according to Dr. Meghan McKeever, lead author and third-year obstetrics and gynecology resident at the University of Rochester Medical Center. Inflammation is thought to be important in the progression of heart disease.

PCOS is a hormone disorder that affects about 7 percent of women of childbearing age and often causes excessive hair growth, irregular and infrequent menstruation, and infertility. Females with PCOS are at increased risk of obesity and other risk factors for heart disease and stroke. Treatment of PCOS, when fertility is not desired, traditionally involves birth control pills, often started during adolescence.

“In PCOS, particularly in patients with obesity, we don’t know what oral contraceptives do to cardiovascular risk factors,” said McKeever’s co-author, Dr. Kathleen Hoeger, associate professor and director of the reproductive endocrinology section at the University of Rochester.

It may take 20 years to see the long-term cardiovascular effect of a treatment in young people, therefore researchers look at other surrogate markers, such as cholesterol levels and, more recently, cytokines, to see if treatments can alter these markers associated with increased risk. C-reactive protein is one cytokine known to be associated with cardiovascular risk. However, it is not clear which other cytokines predict long-term cardiovascular complications.

In 20 obese females ages 12 to 18, McKeever and her co-workers measured levels of C-reactive protein and another cytokine, tumor necrosis factor-alpha, which is produced by fat cells. They compared levels before and six months after treatment with either oral contraceptives or an inactive substance (placebo). Levels of tumor necrosis factor-alpha were significantly higher in patients who received the pill compared with placebo. There also was a trend toward higher levels of C-reactive protein in patients receiving oral contraceptives in this study, which was funded partly by a grant from the National Institutes of Health.

“Longstanding treatment with oral contraceptives for PCOS patients could contribute to worsening cardiovascular risk factors among this already at-risk population,” McKeever said.

The authors recommended that patients with PCOS who are on the pill discuss their risk factors for cardiovascular disease with their doctor.

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