Arteriosclerosis risk. The roles of oral contraceptives and postmenopausal estrogens

Recent studies are reviewed to obtain a perspective on the risk of arteriosclerotic heart disease in women using various oral contraceptive formulations and postmenopausal estrogens. The evidence points to an increasing risk of arteriosclerosis in women after age 40 at a rate parallel to that of men. Arteriosclerosis risk is altered by small changes in lipoprotein concentration--in low-density lipoprotein (LDL) and high-density lipoprotein (HDL) and in a subfraction of HDL, HDL2. There are indications that oral contraceptives alter LDL, HDL and HDL2 concentrations relative to the potency of their estrogen and progestin components and also to the progestin component's associated androgenic effect, with estrogen producing reputedly favorable changes and progestin, unfavorable ones. The risk of arteriosclerosis and myocardial infarction in young women using oral contraceptive steroids is associated with increasing progestin dose, but in most studies, postmenopausal women experience no change or reduced mortality from all causes, including myocardial infarction, with it related in part to increased HDL cholesterol concentrations. It is wise to screen all women patients for hypercholesterolemia, especially those contemplating the use of oral contraceptives. Oral contraceptive steroids should be used cautiously by women with cardiovascular disease risk factors. Formulations must be selected to minimize their potentially adverse effects on lipoprotein physiology.