ABC | Volume 111, Nº6, December 2018

Short Editorial Warning Against Low-Density Lipoprotein Oxidation in Users of Oral Combined Contraceptives Marcelo Chiara Bertolami Instituto Dante Pazzanese de Cardiologia da Secretaria de Estado da Saúde de São Paulo, São Paulo, SP – Brazil Short Editorial regarding to the article: Elevation of Oxidized Lipoprotein of Low Density in Users of Combined Oral Contraceptives Mailing Address: Marcelo Chiara Bertolami • Av. Sabiá, 667 apt. 141. Postal Code 04515-001, Moema, São Paulo, SP – Brazil E-mail: mchiara@cardiol.br, bertolami@dantepazzanese.org.br Keywords Cardiovascular Diseases/mortality; Oxidation; Lipoproteins, LDL; Contraceptives, Oral; Stroke. DOI: 10.5935/abc.20180230 1. Lotufo PA. Cardiovascular diseases in Brazil: premature mortality, risk factors and priorities for action. Comments on the preliminary results from the Brazilian National Health Survey (PNS), 2013. Sao Paulo Med J. 2015; 133(2):69-72. 2. Mansur AP, FavaratoD. Trends inmortality rate fromcardiovascular disease. Arq Bras Cardiol. 2016;107(1):20-5. 3. Nery AB, Mesquita ET, Lugon JR, Kang HC, de Miranda VA, de Souza BG, et al. Prehypertension and cardiovascular risk factors in adults enrolled in a primary care programme. Eur J Cardiovasc Prev Rehabil. 2011;18(2):233-9. 4. Carvalho IS, Silva Jr FL, Brito RS. Internações demulheres em idade fértil por infarto agudo do miocárdio. J Health Sci Inst. 2017;35(3):172-6. 5. Davis M, Diamond J, Montgomery D, Krishnan S, Eagle K, Jackson E. Acute coronary syndrome in young women under 55 years of age: clinical characteristics, treatment, and outcomes. Clin Res Cardiol. 2015 Aug;104(8):648-55. 6. dos Santos ACN, Petto J, Diogo DP, Seixas CR, Souza Lh, Araujo WS, et al. Elevação da lipoproteína de baixa densidade oxidada em usuárias de contraceptivo oral combinado. Arq Bras Cardiol. 2018; 111(6):764-770 7. Gao S, Liu J. Association between circulating oxidized low-density lipoprotein and atherosclerotic cardiovascular disease. Chronic Dis Transl Med.2017;3(2):89-94. 8. Afshin A. Divani AA, Luo X, Datta YH, Flaherty JD, Panoskaltsis-Mortari A. Effect of oral and vaginal hormonal contraceptives on inflammatory blood biomarkers. Mediators of Inflammation. 2015;article ID 379501. 8pages. 9. Hannaford P. Cardiovascular events associatedwith different combined oral contraceptives: a review of current data. Drug Saf. 2000;22(5):361-71. 10. de Bastos M, Stegeman BH, Rosendaal FR, Van Hylckama Vlieg A, Helmerhorst FM, Stijnen T, Dekkers OM. Combined oral contraceptives: venous thrombosis. Cochrane Database Syst Rev. 2014 Mar 3;(3):CDO10813. References This is an open-access article distributed under the terms of the Creative Commons Attribution License Cardiovascular diseases are the main cause of morbidity and mortality in the Western World and in our country. 1 In the last years, this scenario has shown a decrease in the incidence of stroke, formerly the first cause of death. 2 Today, its place has been taken by coronary heart disease. 2 This change was due to better diagnosis and treatment of hypertension, the main cause of strokes, and the increase of the prevalence of risk factors for coronary heart disease such as obesity, diabetes, bad dietary habits, emotional stress and social deprivation, among others. 3 Recently, an increase in myocardial infarction mortality, attributed to several causes, has been observed specifically among Brazilian 4 and North-American 5 young women. The article by dos Santos ACN et al. 6 has focused on one of these possible causes. They studied low-density lipoprotein (LDL) oxidation in users of combined oral contraceptives, showing that this alteration of lipoproteins is increased in this group. LDL oxidation is considered one of the main participants in the atherosclerosis process development, as well as in its major clinical manifestations. 7 They properly discussed the many possible causes of their findings and tried to establish correlations between LDL oxidation with many other variables. They referred to other studies that showed elevated C‑Reactive Protein 8 and blood pressure levels 9 in users of combined oral contraceptives, which along with the known thrombogenicity of these agents (mainly in combination with tobacco smoking), 10 can demonstrate the potential increase in cardiovascular risk in this group. The authors did not specify the types of oral contraceptives that were studied, which could be considered a study limitation. A practical consequence of the presented data is the fact that they are relevant for young women, who will need to find other kinds of contraception, such as IUDs, other oral contraceptives, and other possibilities to prevent the potentially deleterious effects of the combined oral contraceptives. 771