This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. 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 g) 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. 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. 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 application is to obtain pilot data on the extent to which the metabolic syndrome affects cardiovascular risks in women taking OCs. We hypothesize that the metabolic syndrome predicts higher cardiovascular risks in OC users. Results of this study will clarify the risk factors for cardiovascular events in women taking OCs, and will serve as pilot data for an NIH proposal. Once the cardiovascular risk factors of OC users are understood, clinicians can make better informed decisions about contraceptive choices in their patients. The proposed research is innovative, because the effects of the metabolic syndrome on cardiovascular risk factors in OC users have not been previously studied. At the completion of these studies, our expectation is that use of OCs worsens insulin resistance, hypercoagulability and inflammatory markers in women with the metabolic syndrome. Collectively, the results of these studies will clarify the proper candidates for OCs, so that the appropriate use of OCs with the least harm will be possible.
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