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Published on: September 26, 2018
Contraceptive hormone use and cardiovascular disease
Chrisandra L Shufelt1, C Noel Bairey Merz
1Women's Heart Center, Division of Cardiology, Department of Medicine, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Journal of the American College of Cardiology
|January 17, 2009
Summary
Contraceptive hormones, commonly oral contraceptives (OCs), prevent pregnancy but require careful risk-benefit assessment. Newer OCs show no increased heart attack risk but still pose a risk for blood clots.
Area of Science:
- Reproductive Medicine
- Cardiovascular Science
- Pharmacology
Background:
- Oral contraceptives (OCs) are widely used for pregnancy prevention.
- Concerns about cardiovascular risks of hormone therapy, prompted by the Women's Health Initiative, necessitate a review of contraceptive hormone safety.
- Existing data suggest potential antiatheromatous effects of contraceptive hormones, but their impact on atherosclerosis, thrombosis, vasomotion, and arrhythmogenesis requires further investigation.
Purpose of the Study:
- To review the safety, efficacy, and side effects of contraceptive hormones, focusing on cardiovascular implications.
- To evaluate the impact of various contraceptive hormone formulations and delivery methods on cardiovascular health.
- To highlight the need for individualized patient assessment and further research on newer formulations.
Main Methods:
- Review of basic science, animal, and human data.
- Analysis of cardiovascular risk data associated with current and newer generation oral contraceptive formulations.
- Examination of data gaps concerning non-oral contraceptive routes and newest formulations.
Main Results:
- Newer generation OCs do not appear to increase myocardial infarction risk for current users.
- A persistent increased risk of venous thromboembolism is associated with current OC use.
- Cardiovascular data for the newest contraceptive hormone formulations (including those with blood pressure-lowering progestins and non-oral routes) are lacking.
Conclusions:
- Contraceptive hormones, like all medications, require individualized risk-benefit assessment for initiation and selection.
- Women aged 35 and older using contraceptive hormones need thorough cardiovascular risk factor screening (hypertension, smoking, diabetes, etc.).
- Further long-term cardiovascular follow-up studies are essential, particularly for menopausal women with prior OC use, to clarify effects on atherosclerosis and cardiovascular events.
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