EFFECTS OF CONTRACEPTIVE STEROIDS ON CARDIOVASCULAR RISK-FACTORS IN WOMEN WITH INSULIN-DEPENDENT DIABETES-MELLITUS

OBJECTIVE: We evaluated established cardiovascular risk factors within lipoprotein metabolism, hemostasis, and endothelial function in women with insulin-dependent diabetes mellitus who were using oral contrace ptives. STUDY DESIGN: Twenty-five women with uncomplicated insulin-dep endent diabetes mellitus, allocated to treatment with a monophasic com bination of 30 mu g ethinyl estradiol and 75 mu g gestodene (treatment group, n = 12) or with nonhormonal contraception (control group, n = 13), were prospectively followed up for 12 months. Nonparametric metho ds were used for statistical evaluation. RESULTS: No statistical diffe rences in the biochemical risk markers were noted between the two grou ps at the start of the study. In the treatment group serum levels of l ow-density lipoprotein cholesterol decreased, whereas the concentratio ns of total cholesterol, high-density lipoprotein cholesterol, very-lo w-density lipoprotein cholesterol, and triglycerides were unchanged. W ithin the coagulation system factor VII coagulant activity increased, while fibrinogen levels were unchanged. In the fibrinolytic system we found unchanged activities but decreased antigen concentrations of tis sue plasminogen activator and plasminogen activator inhibitor. The con centration of von Willebrand factor increased, but no change in albumi n excretion rates were found. In the control group no changes in any o f the variables were observed. CONCLUSION: Intake of modern oral contr aceptives does not deteriorate the cardiovascular risk profile in wome n with insulin-dependent diabetes mellitus, but our study indicates a risk of disturbances of the endothelial integrity, which needs further investigation.