Oral Contraceptives in the Metabolic Syndrome
| Status: | Completed |
|---|---|
| Conditions: | Obesity Weight Loss, Peripheral Vascular Disease, Endocrine |
| Therapuetic Areas: | Cardiology / Vascular Diseases, Endocrinology |
| Healthy: | No |
| Age Range: | 18 - 40 |
| Updated: | 8/10/2018 |
| Start Date: | June 2005 |
| End Date: | June 2009 |
Oral contraceptives (OCs) are the most widely used method of reversible birth control.
However, the long-term cardiovascular safety of the widely used low-dose OCs
(ethinyl-estradiol < 50 mcg) is still debated. Although cardiovascular events are rare in
young women whether they use OCs or not, the risks of myocardial infarction and ischemic
stroke are increased among users of OCs who have conventional cardiovascular risk factors
such as use of tobacco, diabetes or hypercholesterolemia. However, the risk of cardiovascular
events in OC users with emerging cardiovascular risk factors (such as obesity and the
metabolic syndrome) have not been investigated. Recently, the metabolic syndrome has been
linked with the risk of cardiovascular disease. The syndrome is a clustering of risk factors
in a single individual, and its underlying cause may be insulin resistance. Whether the
metabolic syndrome predicts a higher cardiovascular risk in OC users has not been studied.
This is a critical problem because the metabolic syndrome is prevalent in 24% of adults.
Until the cardiovascular risks in users of OC are clearly defined, the appropriate use of OC
with the least harm would not be possible.
The investigator's long-term goal is to understand the best way to prevent and treat
cardiovascular disease in women. The objective of this particular project is to obtain pilot
data on the extent to which the metabolic syndrome and obesity affects glucose metabolism and
cardiovascular risks in women taking OCs. The researchers hypothesize that women with
metabolic syndrome and obese women will have worsened glucose metabolism and elevated
cardiovascular risks associated with OC use, when compared to normal weight women without the
metabolic syndrome. Results of this study will clarify the risk factors for cardiovascular
events in women taking OCs, and will serve as pilot data for a National Institutes of Health
(NIH) proposal. Once the cardiovascular risk factors of OC users are understood, clinicians
can make better informed decisions about contraceptive choices for their patients.
However, the long-term cardiovascular safety of the widely used low-dose OCs
(ethinyl-estradiol < 50 mcg) is still debated. Although cardiovascular events are rare in
young women whether they use OCs or not, the risks of myocardial infarction and ischemic
stroke are increased among users of OCs who have conventional cardiovascular risk factors
such as use of tobacco, diabetes or hypercholesterolemia. However, the risk of cardiovascular
events in OC users with emerging cardiovascular risk factors (such as obesity and the
metabolic syndrome) have not been investigated. Recently, the metabolic syndrome has been
linked with the risk of cardiovascular disease. The syndrome is a clustering of risk factors
in a single individual, and its underlying cause may be insulin resistance. Whether the
metabolic syndrome predicts a higher cardiovascular risk in OC users has not been studied.
This is a critical problem because the metabolic syndrome is prevalent in 24% of adults.
Until the cardiovascular risks in users of OC are clearly defined, the appropriate use of OC
with the least harm would not be possible.
The investigator's long-term goal is to understand the best way to prevent and treat
cardiovascular disease in women. The objective of this particular project is to obtain pilot
data on the extent to which the metabolic syndrome and obesity affects glucose metabolism and
cardiovascular risks in women taking OCs. The researchers hypothesize that women with
metabolic syndrome and obese women will have worsened glucose metabolism and elevated
cardiovascular risks associated with OC use, when compared to normal weight women without the
metabolic syndrome. Results of this study will clarify the risk factors for cardiovascular
events in women taking OCs, and will serve as pilot data for a National Institutes of Health
(NIH) proposal. Once the cardiovascular risk factors of OC users are understood, clinicians
can make better informed decisions about contraceptive choices for their patients.
Inclusion Criteria:
1. Acceptable health based on interview, medical history, physical examination, and
laboratory tests (comprehensive metabolic panel - SMA20, and complete blood count -
CBC);
2. Have not taken oral contraceptives (OCs) in the past 3 months;
3. Ability to comply with the requirements of the study;
4. Ability and willingness to provide signed, witnessed informed consent. In addition,
women with the metabolic syndrome must meet the National Cholesterol Education Program
(NCEP) defined criteria of the metabolic syndrome, that is, having at least 3 of the 5
factors:
1. increased waist circumference > 35 inches,
2. hypertriglyceridemia ≥ 150 mg/dL,
3. low high-density lipoprotein (HDL) cholesterol < 50 mg/dL in women,
4. hypertension (≥ 130/≥ 85 mmHg),
5. fasting glucose ≥ 100 mg/dL.
Obese women with or without the metabolic syndrome should have a Body Mass Index (BMI) > 30
kg/m2 and lean women should have a Body Mass Index BMI < 25 kg/m2.
Exclusion Criteria:
1. Diabetes mellitus by fasting glucose or a 2-hour oral glucose tolerance test (OGTT);
2. Clinically significant pulmonary, cardiac (including but not limited to ischemic heart
disease, stable/unstable angina, and congestive heart failure), renal, hepatic,
cholestatic, neurologic, psychiatric, infectious, and malignant disease (other than
melanoma skin cancer);
3. History of thromboembolism, myocardial infarction, cerebrovascular accident, vascular
disease, known coagulopathy, prolonged immobilization, or recent major surgery (within
past 6 months);
4. Systolic blood pressure greater than 160 mmHg or diastolic blood pressure greater than
100 mmHg (mild hypertension is not an exclusion criterion);
5. History of breast cancer, migraine headaches, or age ≥ 35 years and smoker of ≥ 20
cigarettes/day;
6. Use of metformin, thiazolidinediones, anti-hyperlipidemic drugs, anti-hypertensive
drugs, glucocorticoids, or anti-androgens (spironolactone, flutamide, etc.) within 3
months;
7. Documented or suspected illicit drug abuse or alcoholism within one year;
8. Ingestion of any investigational drugs within 3 months prior to the study onset; and
9. Pregnancy or lactation (≤ 6 weeks postpartum);
10. Hematocrit < 33g/dL. These exclusion criteria are based on study requirements and also
go beyond guidelines for OC use published by the World Health Organization.
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