Clinical aspects of the relationship between oral contraceptives, abnormalities in carbohydrate metabolism, and the development of cardiovascular disease

Article Abstract:

There is an established link between oral contraceptive (OC) use and cardiovascular disease. In an effort to lower the risk of heart disease, OC formulas have been changed to reduce the amount of estrogen and progesterone contained in them. The risk of cardiovascular disease is increased further in women who smoke and those who have high blood pressure, diabetes and increased blood lipoproteins. The risk of cardiovascular disease diminishes somewhat for OC users who do not have other known risk factors. Since people with diabetes are at risk for cardiovascular disease, it is of interest that OC use also alters the metabolism of glucose. The impact of the low-dose oral contraceptives on the metabolism of glucose and its relationship to cardiovascular disease is discussed. Some studies have reported that impaired glucose tolerance occurs twice as often in OC users than nonusers. In women receiving the high-dose OC pills, impaired glucose tolerance occurred more often in women who had a history of diabetes during pregnancy, older women, obese women, and women with a family history of diabetes mellitus. Impaired glucose tolerance in the high-dose pill users was dependent on the dose and type of hormones used. Women who used the low-dose OC pills (progesterone and estrogen) were less likely to develop glucose intolerance, even with a history of diabetes during pregnancy. How OCs are involved in the mechanisms behind cardiovascular disease is not fully understood. Although the role of a decreased secretion of insulin has not been totally abandoned, it is more likely that insulin resistance at the cellular level causes a decrease in the action of insulin. Factors such as impaired glucose metabolism, diabetes, increased circulating glucose, and increased circulating insulin work together to alter lipid metabolism, which in turn helps create atherosclerotic plaques, fatty accumulations within the blood vessels. Women who have no other cardiovascular risk factors who take low-dose pills with adapted progestogens reduce their risk of cardiovascular heart disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Risk factors, Coronary heart disease, Carbohydrate metabolism, Glucose metabolism

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Effects of ethinyl estradiol combined with desogestrel and cyproterone acetate on glucose tolerance and insulin response to an oral glucose load: a one-year randomized, prospective, comparative trial

Article Abstract:

Oral contraceptives are thought to alter the metabolism of carbohydrates and decrease tolerance to glucose, a simple sugar. Impaired glucose tolerance can be caused by a decrease in the production of insulin (the hormone essential for glucose metabolism), which is secreted by the pancreas, or an increase in insulin resistance, which represents a decrease in the action of insulin at the cellular level. Newer oral contraceptive formulas contain lower doses of estrogen, which have very limited effects on glucose. Progesterone appears to have the most deleterious effects on glucose metabolism. The effects of two low-dose estrogen-dominant oral contraceptive formulas on carbohydrate metabolism were studied among 40 healthy women. Twenty-one women were given 30 micrograms of ethinyl estradiol plus 150 micrograms of desogestrel (Marvelon) and 19 women were given 35 micrograms of ethinyl estradiol plus 2 milligrams of cyproterone (Diane-35). A fasting blood glucose test was given before and six and 12 months after taking the oral contraceptive pills. Blood glucose, insulin, and C-peptide levels (an index of insulin secretion by the pancreas and metabolism by the liver) were measured during an oral glucose challenge. No changes were seen with the Marvelon compound and only slight changes were seen with the Diane-35 compound after six months. At the 12-month mark, both groups had an increased glucose levels, which nevertheless remained within the normal range. The insulin level remained the same in women taking Diane-35. It is thought that there was no change in this group because of insulin resistance. The group receiving Marvelon had a significant decrease in insulin, despite an increase in C-peptide. It is concluded that glucose levels are increased, insulin secretion by the pancreas is stimulated and the clearance of insulin by the liver is enhanced when women take ethinyl estradiol combined with either desogestrel or cyproterone. (Consumer Summary produced by Reliance Medical Information, Inc.)

Blood sugar, Blood glucose, Insulin, Estradiol

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Comparative studies of 30 micrograms of ethinyl estradiol combined with gestodene and desogestrel on blood coagulation, fibrinolysis, and platelets

Article Abstract:

There is an association between oral contraceptive (OC) use and cardiovascular disease. Woman who take OCs are at risk for the formation of blood clots (thrombosis), which can block blood vessels serving the heart, lungs, brain and legs. Newer low-dose OC formulas are thought to reduce the risk of thrombosis. One of two OC formulas, 30 micrograms of ethinyl estradiol plus 75 micrograms of gestodene or 150 micrograms of desogestrel, was given to 60 healthy women. Factors involved in the formation and inhibition of clots were measured before, at 12, 24, 36 and 48 weeks of treatment, and 6 and 12 weeks after treatment. Factors involved in the clot dissolving process (fibrinolysis) and platelet activity (the cells that clump and secrete clotting factors) were examined. Both low-dose formulas altered the blood clotting system similarly. Factors VII and X were higher in women who took the estradiol/desogestrel formula than in women receiving the estradiol/gestodene formula. This may have been caused by the estrogen-dominant effect of the estradiol/desogestrel formula. Therefore, there still seems to be a risk of thrombosis with the low-dose oral contraceptive formulas. (Consumer Summary produced by Reliance Medical Information, Inc.)

Blood coagulation factors, Blood platelets, Progesterone, Fibrinolysis, Ethinyl estradiol

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