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      Oral Contraceptives and Cardiovascular Risk: Adding Clinical Evidence to the Pathophysiology

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          Contraceptive hormone use and cardiovascular disease.

          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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            Female hormones and thrombosis.

            Exogenous hormones are used by more than a hundred million women worldwide as oral contraceptives or for postmenopausal hormone replacement. Oral contraceptives increase the risk of venous thrombosis, of myocardial infarction, and of stroke. The risk is highest during the first year of use. The venous thrombotic risk of oral contraceptives is high among women with coagulation abnormalities and with so-called third-generation contraceptives (containing desogestrel or gestodene). The risk of myocardial infarction does not appear to depend on coagulation abnormalities or the type of oral contraceptive. Hormone replacement therapy increases the risk of venous thrombosis. This risk is also highest in the first year of use and among women with coagulation abnormalities. The risk becomes very high in women with a previous venous thrombosis. Randomized trials have not confirmed a beneficial effect of postmenopausal hormones on the occurrence of myocardial infarction.
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              Association between duration of oral contraceptive use and risk of hypertension: A meta-analysis

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                Author and article information

                Journal
                ijcs
                International Journal of Cardiovascular Sciences
                Int. J. Cardiovasc. Sci.
                Sociedade Brasileira de Cardiologia (Rio de Janeiro, RJ, Brazil )
                2359-4802
                2359-5647
                May 2020
                : 33
                : 3
                : 215-216
                Affiliations
                [2] Rio de Janeiro Rio de Janeiro orgnameUniversidade do Estado do Rio de Janeiro Brazil
                [1] Rio de Janeiro RJ orgnameInstituto Nacional de Cardiologia Brazil
                Article
                S2359-56472020000300215 S2359-5647(20)03300300215
                10.36660/ijcs.20200078
                54091baf-9369-40f7-b089-c5b793762049

                This work is licensed under a Creative Commons Attribution 4.0 International License.

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                Figures: 0, Tables: 0, Equations: 0, References: 10, Pages: 2
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                SciELO Brazil


                Blood Coagulation Factors,Oral Contraceptives/adverse effects,Oxidative Stress/drug effects,Hypertension,Woman,Morbidity

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