Oral Contraceptives in the Metabolic Syndrome

Condition(s) targeted: Metabolic Syndrome X; Insulin Resistance; Obesity; Cardiovascular Diseases

Intervention: Ortho Tri Cyclen (Drug)

Phase: Phase 4

Status: Recruiting

Sponsored by: Virginia Commonwealth University

Official(s) and/or principal investigator(s):
Kai I Cheang, Pharm.D., Principal Investigator, Affiliation: Virginia Commonwealth University
John E Nestler, M.D., Study Director, Affiliation: Virginia Commonwealth University
Paulina A Essah, M.D., Study Director, Affiliation: Virginia Commonwealth University

Overall contact:
Kai I Cheang, Pharm.D., Phone: 804-828-9698, Email: kicheang@vcu.edu

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 have not been investigated. One such emerging cardiovascular risk factor is the metabolic syndrome, or obesity. 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 affects cardiovascular risks in women taking OCs. The researchers hypothesize that women with metabolic syndrome and obese women will have higher cardiovascular risks associated with OC use. 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.

Official title: Oral Contraceptives in the Metabolic Syndrome

Study design: Prevention, Non-Randomized, Open Label, Active Control, Parallel Assignment, Safety Study

Primary outcome:

Difference in insulin sensitivity changes associated with oral contraceptive use compared among (1)obese women with the metabolic syndrome, (2) obese women without the metabolic syndrome, and (3) lean women without the metabolic syndrome

Inflammatory and insulin sensitivity marker changes (CRP,PAI-1,tPA,adiponectin,VCAM,ICAM,RBP4,Futuin-A and others) associated with OC use compared among (1)obese women with and(2)without metabolic syndrome, and(3)lean women without metabolic syndrome

Secondary outcome: Changes in lipid profile, blood pressure, weight, waist-hip ratio and other anthropometric measures associated with OC use among (2)obese women with and (2) without metabolic syndrome, and (3) lean women without metabolic syndrome

Minimum age: 18 Years. Maximum age: 40 Years. Gender(s): Female.

Criteria:

Inclusion Criteria:

1. Acceptable health based on interview, medical history, physical examination, and laboratory tests (SMA20 and CBC);

2. Have not taken 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 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 BMI > 30 kg/m2 and lean women should have a 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.

Kai I Cheang, Pharm.D., Phone: 804-828-9698, Email: kicheang@vcu.edu

Virginia Commonwealth University General Clinical Research Center, Richmond, Virginia 23298, United States; Recruiting
Kai I Cheang, Pharm.D., Phone: 804-828-9698, Email: kicheang@vcu.edu
Kai I Cheang, Pharm.D., Principal Investigator
John E Nestler, M.D., Sub-Investigator
Paulina A Essah, M.D., Sub-Investigator

Starting date: June 2005
Ending date: February 2010
Last updated: February 17, 2009