Newer generation oral contraceptive formulations indicate no increased myocardial infarction risk for current users, but carry a persistent increased risk of venous thromboembolism.
Does contraceptive hormone use impact the risk of cardiovascular disease and venous thromboembolism in women?
Newer generation oral contraceptives do not increase myocardial infarction risk but carry a persistent risk of venous thromboembolism, necessitating individualized risk assessment prior to initiation, especially in women aged 35 and older.
Contraceptive hormones, most commonly prescribed as oral contraceptives (OC), are a widely utilized method to prevent ovulation, implantation and therefore pregnancy. The Women’s Health Initiative demonstrated cardiovascular risk linked to menopausal hormone therapy among women without pre-existing cardiovascular disease, prompting review of the safety, efficacy and side effects of other forms of hormone therapy. A variety of basic science, animal and human data suggest that contraceptive hormones have anti-atheromatous effects, however relatively less is known regarding the impact on atherosclerosis, thrombosis, vasomotion and arrhythmogenesis. Newer generation OC formulations currently in use indicate no increased myocardial infarction (MI) risk for current users, but a persistent increased risk of venous thrombo-embolism (VTE). There are no cardiovascular data available for the newest generation contraceptive hormone formulations, including those that contain newer progestins that lower blood pressure, as well as the non-oral routes (topical and vaginal). Current guidelines indicate that, as with all medication, contraceptive hormones should be selected and initiated by weighing risks and benefits for the individual patient. Women 35 years and older should be assessed for cardiovascular risk factors including hypertension, smoking, diabetes, nephropathy and other vascular diseases including migraines, prior to use. Existing data are mixed with regard to possible protection from OC for atherosclerosis and cardiovascular events; longer-term cardiovascular follow-up of menopausal women with regard to prior OC use, including subgroup information regarding adequacy of ovulatory cycling, the presence of hyperandrogenic conditions, and the presence of prothrombotic genetic disorders is needed to address this important issue.
Shufelt et al. (Thu,) conducted a review in Cardiovascular disease. Contraceptive hormones was evaluated. Newer generation oral contraceptive formulations indicate no increased myocardial infarction risk for current users, but carry a persistent increased risk of venous thromboembolism.