The results of a study published in the June issue of the Journal of
Clinical Endocrinology and Metabolism suggest an association between
the use of low-dose oral contraceptives and an increase in markers
of cardiovascular risk in African American women.

In white women, oral contraceptive use has been found to increase
cardiovascular risk by promoting insulin resistance, glucose
intolerance, and hypertriglyceridemia, Dr. Anne E. Summer and
colleagues from the National Institutes of Health, Bethesda,
Maryland, report.

"However, compared with white women, African American women are more
insulin resistant, have a higher prevalence of glucose intolerance,
and paradoxically lower triglyceride levels," the investigators
note. "Therefore, the metabolic effects of oral contraceptive pills
observed in white women cannot be extrapolated to African American
women."

In a cross-sectional study, the researchers examined the effect of
oral contraceptives on insulin resistance, glucose intolerance, and
triglycerides in 104 healthy, non-diabetic African American women.
Of these subjects, 21 were oral contraceptive pill users and 83 were
non-users (controls).

The subjects had a mean age of 34.7 years and a mean BMI of 31. The
participants underwent a variety of tests, such as oral glucose
tolerance and fasting lipid profiles.

Fasting glucose did not significantly differ between oral
contraceptive pill users and non-users.

The women who used oral contraceptives had significantly higher 2-h
glucose and fasting triglycerides, and were significantly more
insulin resistant than controls.

The results of multiple regression analysis demonstrated that BMI,
age, and oral contraceptive pill use were significant determinants
of 2-h glucose. These factors were also significantly predictive of
high triglyceride levels.

The authors repeated their analyses after categorizing the
participants as non-obese (BMI < 30) or obese.

Non-obese oral contraceptive pill users were more insulin resistant
than controls. Compared with controls, non-obese oral contraceptive
pill users were also more likely to be glucose intolerant.

"Assessing the risks and benefits of oral contraceptive pill use is
complex and requires careful consideration in African Americans,"
the investigators conclude.

J Clin Endocrinol Metab 2008;93:2097-2103.