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Clinical aspects of the relationship between oral contraceptives, abnormalities in carbohydrate metabolism, and the development of cardiovascular disease.
Am J Obstet Gynecol. 1990 Jul; 163(1 Pt 2):334-43.AJ

Abstract

Although large epidemiologic studies indicated no difference in the frequency of diabetes mellitus in nonusers and everusers of high-dose combination oral contraceptives, other studies had shown an increased risk of impaired glucose tolerance in current users, which is estimated to be roughly twice as frequent as that in nonusers. Women at risk of developing impaired glucose tolerance while receiving high-dose oral contraceptives either had previous gestational diabetes mellitus or were older, obese, or had a positive family history of diabetes mellitus. The tendency to decreased glucose tolerance seems essentially related to the dosage and chemical structure of the progestogen used in oral contraceptives, namely, estrane and particularly gonane progestins. However, increased frequency of impaired glucose tolerance and potentially diabetes mellitus are obviously not linked to the use of the more potent gonane progestins. The use of low-dose oral contraceptives, particularly with reduced progestogen content (such as in the triphasic formulations and last-generation monophasic preparations), is accompanied by a low risk of impaired glucose tolerance, even in previous gestational diabetes mellitus. The mechanism of decreased glucose tolerance in oral contraceptive users is unknown but seems related partially to increased peripheral resistance that is potentially caused by a postreceptor defect in insulin action. Changes in insulin production or metabolic clearance rate are not excluded by recent, sophisticated investigations of carbohydrate metabolism in oral contraceptive users. Impaired glucose tolerance and diabetes mellitus, chronic hyperglycemia, and hyperinsulinemia are believed to increase atherogenic risk either by their direct action or their effects on lipid metabolism. Newer epidemiologic studies now indicate that the incidence of cardiovascular disease in low-dose, low-risk, current oral contraceptive users has been substantially decreased. The use of low-dose oral contraceptives with reduced dosages of better adapted progestogens seems effective in decreasing alterations in carbohydrate metabolism and may thereby contribute to decrease further atherogenic risk in oral contraceptive users.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, University of Liège, Belgium.No affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

2196805

Citation

Gaspard, U J., and P J. Lefebvre. "Clinical Aspects of the Relationship Between Oral Contraceptives, Abnormalities in Carbohydrate Metabolism, and the Development of Cardiovascular Disease." American Journal of Obstetrics and Gynecology, vol. 163, no. 1 Pt 2, 1990, pp. 334-43.
Gaspard UJ, Lefebvre PJ. Clinical aspects of the relationship between oral contraceptives, abnormalities in carbohydrate metabolism, and the development of cardiovascular disease. Am J Obstet Gynecol. 1990;163(1 Pt 2):334-43.
Gaspard, U. J., & Lefebvre, P. J. (1990). Clinical aspects of the relationship between oral contraceptives, abnormalities in carbohydrate metabolism, and the development of cardiovascular disease. American Journal of Obstetrics and Gynecology, 163(1 Pt 2), 334-43.
Gaspard UJ, Lefebvre PJ. Clinical Aspects of the Relationship Between Oral Contraceptives, Abnormalities in Carbohydrate Metabolism, and the Development of Cardiovascular Disease. Am J Obstet Gynecol. 1990;163(1 Pt 2):334-43. PubMed PMID: 2196805.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical aspects of the relationship between oral contraceptives, abnormalities in carbohydrate metabolism, and the development of cardiovascular disease. AU - Gaspard,U J, AU - Lefebvre,P J, PY - 1990/7/1/pubmed PY - 1990/7/1/medline PY - 1990/7/1/entrez KW - Biology KW - Carbohydrate Metabolic Effects KW - Cardiovascular Effects--etiology KW - Contraception KW - Contraceptive Agents, Female--side effects KW - Contraceptive Agents, Progestin--side effects KW - Contraceptive Agents--side effects KW - Contraceptive Methods--side effects KW - Cyproterone Acetate--side effects KW - Data Collection KW - Endocrine System KW - Examinations And Diagnoses KW - Family Planning KW - Glucose Metabolism Effects KW - Hormone Antagonists KW - Hormones KW - Laboratory Examinations And Diagnoses KW - Metabolic Effects KW - Norethindrone--side effects KW - Oral Contraceptives, Low-dose--side effects KW - Oral Contraceptives--side effects KW - Physiology KW - Research Methodology SP - 334 EP - 43 JF - American journal of obstetrics and gynecology JO - Am J Obstet Gynecol VL - 163 IS - 1 Pt 2 N2 - Although large epidemiologic studies indicated no difference in the frequency of diabetes mellitus in nonusers and everusers of high-dose combination oral contraceptives, other studies had shown an increased risk of impaired glucose tolerance in current users, which is estimated to be roughly twice as frequent as that in nonusers. Women at risk of developing impaired glucose tolerance while receiving high-dose oral contraceptives either had previous gestational diabetes mellitus or were older, obese, or had a positive family history of diabetes mellitus. The tendency to decreased glucose tolerance seems essentially related to the dosage and chemical structure of the progestogen used in oral contraceptives, namely, estrane and particularly gonane progestins. However, increased frequency of impaired glucose tolerance and potentially diabetes mellitus are obviously not linked to the use of the more potent gonane progestins. The use of low-dose oral contraceptives, particularly with reduced progestogen content (such as in the triphasic formulations and last-generation monophasic preparations), is accompanied by a low risk of impaired glucose tolerance, even in previous gestational diabetes mellitus. The mechanism of decreased glucose tolerance in oral contraceptive users is unknown but seems related partially to increased peripheral resistance that is potentially caused by a postreceptor defect in insulin action. Changes in insulin production or metabolic clearance rate are not excluded by recent, sophisticated investigations of carbohydrate metabolism in oral contraceptive users. Impaired glucose tolerance and diabetes mellitus, chronic hyperglycemia, and hyperinsulinemia are believed to increase atherogenic risk either by their direct action or their effects on lipid metabolism. Newer epidemiologic studies now indicate that the incidence of cardiovascular disease in low-dose, low-risk, current oral contraceptive users has been substantially decreased. The use of low-dose oral contraceptives with reduced dosages of better adapted progestogens seems effective in decreasing alterations in carbohydrate metabolism and may thereby contribute to decrease further atherogenic risk in oral contraceptive users. SN - 0002-9378 UR - https://www.unboundmedicine.com/medline/citation/2196805/Clinical_aspects_of_the_relationship_between_oral_contraceptives_abnormalities_in_carbohydrate_metabolism_and_the_development_of_cardiovascular_disease_ L2 - https://linkinghub.elsevier.com/retrieve/pii/0002-9378(90)90578-U DB - PRIME DP - Unbound Medicine ER -