Context: Effect of OCP-use on cardiovascular risk in African-American women is unknown.

Objective: To examine in African-American women, the effect of OCP-use on insulin resistance, glucose intolerance and triglycerides (TG).

Design: Cross-sectional study

Setting: Study was conducted at the National Institutes of Health Clinical Research Center

Participants: One-hundred-four healthy non-diabetic African-American women (21 OCP-users, 83 controls, age mean±SD, 34.7±7.6years, BMI 31±8.4kg/m²)

Interventions: Subjects had oral glucose tolerance tests (OGTT), insulin modified-frequently sampled intravenous 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.

Results: Fasting glucose did not differ between OCP-users and controls (P=0.27). In contrast, compared to controls, 2-hour glucose (135±23 vs.120±25 mg/dL, P=0.01) and fasting TG (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-hour glucose (adjR²=0.37; P<0.001) and TG levels (adjR²=0.21; P<0.001). As BMI was a determinant of both 2-hour glucose and TG, participants were divided into non-obese and obese groups and the analyses repeated. Among the non-obese women, the OCP-users were more insulin resistant (S_I: 2.91±1.58 vs. 4.35±1.88, P=0.03) and had higher prevalence of glucose intolerance than controls (OR 5.7; 95% CI 1.4–24, P=0.01).

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