Smoking, Oral Contraceptives, and Cardiovascular Reactivity to Stress

In Brief Objective To investigate the effects of smoking and oral contraceptive (OC) formulation on hemodynamic responses to stress in women. Methods Twenty-three smokers and 23 nonsmokers taking different OC formulations (ie, containing higher or lower androgenic progesterones) were tested for cardiovascular reactivity during mathematic, speech preparation, speech, and cold pressor stress. Results During mental stress, smokers, regardless of OC formulation, had lower systolic blood pressure (BP) (eg, 10.2 versus 15.1 mmHg, P < .05), heart rate (eg, 7.5 versus 15.0 beats per minute, P < .01), and cardiac index reactivity (eg, 0.08 versus 0.48 L/minute/M2, P < .01) but greater vascular resistance index responses (eg, 115.6 versus −51.9 dyne-sec • cm−5 • M2, P < .05). Women who took higher androgen OCs, regardless of smoking status, showed greater vascular resistance index increases during speech stress than those who took lower androgen OCs (215.8 versus 9.4 dyne-sec • cm−5 • M2, P < .05). Smokers who took more androgenic OCs had greater systolic BP responses to speech preparation compared with nonsmokers who took the same OCs (12.1 versus 6.1 mmHg, P < .05), and smokers who took lower androgen OCs (12.1 versus 4.4 mmHg, P < .05). Least-squares means examination found that smokers who took higher androgen OCs had greater vascular resistance index increases to all mental stressors than nonsmokers who took lower androgen OCs. Conclusion Higher androgen OCs might be linked to greater vascular and BP increases during stress, especially in smokers. Given that increased vascular resistance and BP contribute to cardiovascular mortality, those results suggest that androgenic profiles of synthetic progesterones might be an important consideration in OC choice. Smoking status and type of progesterone influence cardiovascular reactivity to stress in oral contraceptive users.