Pros and cons of the Pill tricky for black women

NEW YORK (Reuters Health) - African-American women taking a low-dose oral contraceptive may see an increase in markers of increased risk for developing heart disease or diabetes, a study shows.

In white women, oral contraceptives promote resistance to the effects of insulin, reduced ability to process glucose, and high levels of triglyceride fats in the blood, Dr. Anne E. Summer and colleagues from the National Institutes of Health, Bethesda, Maryland, point out in the Journal of Clinical Endocrinology.

These effects are linked to metabolic syndrome, which can lead to heart disease and diabetes.

However, the pattern of risk factors generally differs in black women. "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 pill observed in white women cannot be extrapolated to African-American women."

To look into this, 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 taking oral contraceptive pills and 83 were non-users (controls).

The participants underwent a variety of tests, such as to measure blood lipid levels while fasting and to determine tolerance to an oral dose of glucose.

The women who used oral contraceptives had significantly higher glucose levels at 2 hours on the glucose tolerance test and they had higher fasting triglyceride levels. They were also significantly more resistant to insulin than the controls.

Analysis of the data demonstrated that oral contraceptive pill use a significant determinant of 2-hour glucose and triglyceride levels, as was body mass index.

The researchers therefore divided the participants into non-obese (BMI less than 30) and obese groups, and repeated the analysis. This showed that non-obese oral contraceptive pill users were more insulin resistant than controls and were 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.

SOURCE: Journal of Clinical Endocrinology, June 2008.