Oral Contraceptives and Cardiovascular Risk: Adding Clinical Evidence to the Pathophysiology
Daniel Arthur B. Kasal
Andrea De Lorenzo
Women cardiovascular health is an important and often neglected issue. Cardiovascular diseases (CVDs) are the main cause of death in women, in Brazil and worldwide.1 Oral contraceptives are the main method used for contraception in Brazil.2 The issue of oral contraceptives and cardiovascular risk has been raised since the first descriptions of this class of pharmaceuticals, in the 1960s. The development of low-dose combined oral contraceptives (COCs) containing ethinyl estradiol and different progestins has reduced, albeit not eliminated, cardiovascular morbidity in women taking these medications.3 The main side effects associated with COCs are procoagulant effects. Therefore, the use of COCs is associated with increased risk of developing acute myocardial infarction, venous thromboembolism and stroke.4 In addition, adverse changes in the lipid profile and glucose tolerance have been described.5 Clearly, ageing and exposure to other risk factors, mainly smoking and obesity, play an important role in the development of adverse outcomes related to COCs. In addition, formulations with different progestins may produce distinct effects on circulation.6
Keywords: Oral Contraceptives/adverse effects; Blood Coagulation Factors; Oxidative Stress/drug effects; Hypertension; Woman; Morbidity.