Cardiovascular contraceptives

A final area of research focuses on how the piU. can best be used by women. Physicians used to recommend pid-free hoHdays, but it is now known that there is no vaUd reason for this practice. Similarly, further research indicated that the U.S. EDA s restrictive guidelines for prescribing the piU. to women over the age of 35 are not justified, and those guidelines have been changed. EinaHy it is clear that cigarette smoking increases the risk of cardiovascular side effects, especially in women over 35 who utilize combination oral contraceptives. 

Future efforts should be directed at optimizing current formulations to finally come up with an ideal oral contraceptive which would reduce the risk of breast, ovarian and endometrial cancer without any cardiovascular complications. 

A wealth of epidemiological, clinical, and experimental studies link estrogens with cardiovascular disease (CVD). This evidence has promoted CVD as a key area within the extragenital effects of estrogens. The question is of interest because it directly affects the wide clinical use of estrogens as contraceptive agents or as principal constituents of hormonal therapy (HT) formulations in postmenopausal women. The significance of the subject is further reinforced by the relevance of CVD as a cause of mortality and morbidity in both women and men. 

Hannaford PC, Owen-Smith V (1998) Using epidemiological data to guide clinical practice review of studies on cardiovascular disease and use of combined oral contraceptives. Br Med J 316 984-987... 

Cigarette smoking Cigarette smoking increases the risk of cardiovascular side effects from hormonal contraceptive use. This risk increases with age and with heavy smoking (15 or more cigarettes/day) and is quite marked in women more than 35 years of age. Women who use hormonal contraceptives should not smoke. 

Contraindications for oral contraceptives form episodes of thrombosis or embolism and cardiovascular disease. Estrogen containing pills should not be used immediately postpartum since they can interfere with lactation. 

Used as long-acting depot preparations intramuscularly administered medroxyprogesterone acetate provides contraception for up to 3 months and norethisterone enanthate up to 2 months. These preparations can be indicated when compliance can pose problems. They are not associated with thromboembolism or cardiovascular disease. Adverse reactions are abnormal and prolonged bleeding and amenorrhoea. 

Chasan-Taber L, Stampfer MJ. Epidemiology of oral contraceptives and cardiovascular disease. Ann Int Med 1998 128 467-77. 

Figure 1.4 Percentage of drugs that have been prescribed in the United States for 2003-2005 as a fraction of the top 200 most prescribed drugs. Note that the total of the top 200 most prescribed was 2.1 bilhon, 2.8 biUion, and 2.3 billion for 2003, 2004 and 2005, respectively. AC = Antihypertension/cardiovascular medication, SH = sedatives/antipsychotics, AI = analgesics/anti-inflammatory, AM = antimicrobial, GI = gastrointestinal, AD = antidiabetic, DE = diuretics/electrol3ftes, TH = thyroid drugs. Re = respiratory, CR = contraceptives/ reproductive therapy, BP = biophosphonates and other anti-bone loss, St = steroids. He = hematology, Nu = nutritional, Tr = triptan, AP = antineoplast, AN = anesthetic, and DI = dopaminergics and immunomodulators.

In summary, available data indicate that oral contraceptives increase the risk of various cardiovascular disorders at all ages and among both smokers and nonsmokers. However, this risk appears to be concentrated in women 35 years of age or older who are heavy smokers. It is clear that these risk factors must be considered in each individual patient for whom oral contraceptives are being considered. Some... 

The cardiovascular complications of oral contraceptives include venous thrombosis and thromboembolism, arterial damage, and hypertension. 

The increase in risk with age is clear (6), although the underlying risk of cardiovascular disease also rises as age progresses. The US Food and Drug Administration has concluded that the benefits may outweigh the risks in healthy non-smoking women over age 40, and it has in most countries been common for over two decades to advise reticence in the use of oral contraceptives after the age of 35. 

Lipid changes seen with the most widely used combined oral contraceptives comprise an increase in low density lipoprotein and reductions in high density lipoprotein and cholesterol. The third-generation products have these effects to a much smaller extent, leading to claims that they would be less likely to have long-term adverse cardiovascular effects related to atherosclerosis. However, such a claim reflects an all too readily adopted belief that the lipid changes produced by the more traditional combined oral contraceptives are in this respect capable of causing this type of (primarily arterial) cardiovascular disease. This is of itself far from certain. 

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