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Review
. 2009 Jan 20;53(3):221-31.
doi: 10.1016/j.jacc.2008.09.042.

Contraceptive hormone use and cardiovascular disease

Chrisandra L Shufelt  1 , C Noel Bairey Merz
Affiliations
Review

Contraceptive hormone use and cardiovascular disease

Chrisandra L Shufelt et al. J Am Coll Cardiol. .

Erratum in

  • J Am Coll Cardiol. 2009 Mar 10;53(10):904

Abstract

Contraceptive hormones, most commonly prescribed as oral contraceptives (OCs), 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 a review of the safety, efficacy, and side effects of other forms of hormone therapy. A variety of basic science, animal, and human data suggests that contraceptive hormones have antiatheromatous effects; however, relatively less is known regarding the impact on atherosclerosis, thrombosis, vasomotion, and arrhythmogenesis. Newer generation OC formulations in use indicate no increased myocardial infarction risk for current users, but a persistent increased risk of venous thromboembolism. 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 nonoral routes (transdermal 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 OCs 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.

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Conflict of interest statement

Disclosure: There are no relevant conflicts of interest of any of the authors to disclose.

Figures

Figure 1
Figure 1
Impact of Hormonal Contraception on Mechanisms of Cardiovascular Disease. Estrogens and progestins individual effects on atherosclerosis, thrombosis, vasomotion and arrhythmogenesis. (12,14,28-37,42,51,52,76,78).
Figure 2
Figure 2
Coronary artery severity score, assessed by quantitative coronary angiography, stratified by reported prior oral contraceptive use. Past OC hormone use was associated with a reduced risk of atherosclerotic coronary artery disease. Reprinted by permission (75).
See this image and copyright information in PMC

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