Hormonal contraception: venous and arterial disease

Abstract

Objectives: The aim of this review was to evaluate whether the biological and epidemiological evidence is concordant in suggesting that levonorgestrel (LNG)-based hormonal contraceptives (HCs) are safer than newer formulations with regard to their effect on the cardiovascular system.

Methods: A narrative review was carried out of the modification of risk factors for venous thromboembolism (VTE) and arterial diseases induced by different HCs. Limits and concordance with epidemiological data were addressed.

Results: The data indicate general concordance between modifications of risk factors and epidemiology of VTE, with LNG-based HCs showing lower risk compared with most new formulations. Evidence for drospirenone (DRSP)-containing HCs is conflicting. LNG-based HCs are less favourable than HCs containing non-androgenic progestins, particularly DRSP, on risk factors for arterial events. Epidemiological studies do not consistently show a difference in arterial disease outcomes between different HCs; however, by evaluating women up to the age of 50, they do not take into consideration the time lag necessary for atherosclerosis to develop.

Conclusions: As a consequence of the different risk factors involved, and the different time lags between HC use and the manifestation of VTE or arterial diseases, the available epidemiological data do not give a reliable estimate of the cardiovascular risk associated with the use of different HCs. LNG-based HCs are safer than newer HCs as regards VTE risk, but biological data indicate that they are less favourable, particularly than HCs containing DRSP, on risk factors for atherosclerosis. Because of the limits of actual epidemiological evidence regarding arterial disease, modifications of arterial risk factors should be taken into consideration when considering individual long-term safety of HC use.

Chinese abstract

目的：本综述的目的是评估是否有生物和流行病学证据可以表明以左炔诺孕酮（LNG）为基础的激素避孕药（HCS）对心血管系统的影响比新配方更安全。

方法：对静脉血栓栓塞（VTE）和由不同的HCs引起的动脉疾病风险因素的修正进行综述。并对流行病学数据的限制与一致性进行讨论。

结果：数据表明危险因素的修正与VTE流行病学大体一致, 含有LNG的HCS与大部分新配方相比较, 其有较低风险。含屈螺酮（DRSP）的HCS证据有争议。对动脉疾病的危险因素方面, 含有LNG的HCS与含有非雄激素孕激素的HCS相比, 特别是DRSP, 其支持证据更少。流行病学研究没有一贯表明使用不同的HCS会对动脉疾病的预后有不同影响。然而, 通过评估50岁以上的妇女, 他们没有考虑到动脉粥样硬化发展所需的时间滞后。

结论：由于不同的危险因素和不同的时间滞后, 在HC的使用与VTE或动脉疾病表现之间, 现有的流行病学数据就使用不同HCS引起的心血管风险不能给出可靠的评估。使用含有LNG的HCS在VTE风险方面比使用新的HCs更安全, 但生物数据表明其对动脉粥样硬化有危险则支持较少, 特别是比含有DRSP的HCs。因关于动脉疾病实际的流行病学证据有限, 当考虑个人需长期安全使用HC时, 应当考虑动脉危险因素的修正。

Keywords:

• Blood pressure
• coagulation
• glucose
• hormonal contraceptives
• lipoprotein
• myocardial infarction
• stroke
• thromboembolism

Disclosure statement

The author is a speaker and advisory board member for MSD, Bayer Italia, Gedeon-Richter and Teva Italia.