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Effect of Low-Dose Oral Contraceptives on Metabolic Risk Factors in African-American Women

Clinical Endocrinology Branch, National Institutes of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892-1612

Address all correspondence and requests for reprints to: Anne E. Sumner, M.D., National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 9000 Rockville Pike, Building 10-CRC, Room 6-5940, MSC 1612, Bethesda, Maryland 20892. E-mail: annes{at}intra.niddk.nih.gov.

Context: The effect of oral contraceptive pill (OCP) use on cardiovascular risk in African-American women is unknown.

Objective: Our objective was to examine in African-American women the effect of OCP use on insulin resistance, glucose intolerance, and triglycerides (TGs).

Design: This was a cross-sectional study.

Setting: The study was conducted at the National Institutes of Health Clinical Research Center.

Participants: A total of 104 healthy nondiabetic African-American women [21 OCP users, 83 controls, age mean ± SD, 34.7 ± 7.6 yr, body mass index (BMI) 31 ± 8.4 kg/m²] was included in the study.

Interventions: Subjects had oral glucose tolerance tests, insulin-modified frequently sampled iv glucose tolerance tests, and fasting lipid profiles. Insulin resistance was determined by the insulin sensitivity index (S_I).

Main Outcome Measures: Insulin resistance, glucose tolerance status, and TG levels were determined.

Results: Fasting glucose did not differ between OCP users and controls (P = 0.27). In contrast, compared with controls, 2-h glucose (135 ± 23 vs.120 ± 25 mg/dl; P = 0.01) and fasting TGs (73 ± 31 vs.57 ± 27 mg/dl; P = 0.02) were higher in OCP users. OCP users tended to be more insulin resistant than controls (S_I: 2.51 ± 2.01 vs. 3.46 ± 2.09; P = 0.09). Multiple regression analysis revealed that BMI, age, and OCP use were significant determinants of 2-h glucose (adjusted R² = 0.37; P < 0.001) and TG levels (adjusted R² = 0.21; P < 0.001). As BMI was a determinant of both 2-h glucose and TGs, participants were divided into nonobese and obese groups, and the analyses repeated. Among the nonobese women, the OCP users were more insulin resistant (S_I: 2.91 ± 1.58 vs. 4.35 ± 1.88; P = 0.03) and had a higher prevalence of glucose intolerance than controls (odds ratio 5.7; 95% confidence interval 1.4–24; P = 0.01).

Conclusion: In African-American women, OCP use is associated with an increase in markers of cardiovascular risk manifested by increased insulin resistance, glucose intolerance, and elevated TGs.