Contraceptive hormone use and cardiovascular disease
Open accessAbstract
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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Observational studies indicate that early treatment in children with familial hypercholesterolaemia attenuates the development of atherosclerosis.
“Although there have been no placebo-controlled trials in children, observational studies have suggested that early treatment can reduce LDL-C burden, improve endothelial function, substantially attenuate the development of atherosclerosis, and improve coronary outcomes [369-371].”
From 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk (2019) · cites this paper as [370]
Observational studies indicate that early treatment in children with familial hypercholesterolaemia improves endothelial function.
“Although there have been no placebo-controlled trials in children, observational studies have suggested that early treatment can reduce LDL-C burden, improve endothelial function, substantially attenuate the development of atherosclerosis, and improve coronary outcomes [369-371].”
From 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk (2019) · cites this paper as [370]
Observational studies indicate that early treatment in children with familial hypercholesterolaemia lowers LDL-C burden.
“Although there have been no placebo-controlled trials in children, observational studies have suggested that early treatment can reduce LDL-C burden, improve endothelial function, substantially attenuate the development of atherosclerosis, and improve coronary outcomes [369-371].”
From 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk (2019) · cites this paper as [370]
Observational studies indicate that early treatment in children with familial hypercholesterolaemia improves coronary outcomes.
“Although there have been no placebo-controlled trials in children, observational studies have suggested that early treatment can reduce LDL-C burden, improve endothelial function, substantially attenuate the development of atherosclerosis, and improve coronary outcomes [369-371].”
From 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk (2019) · cites this paper as [370]
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Unique cardiometabolic factors in women that contribute to modified cardiovascular disease risk
Hetherington, K., Thomas, J., Nicholls, S. J., Barsha, G., & Bubb, K. J. (2024) · European Journal of Pharmacology · doi:10.1016/j.ejphar.2024.177031 · Cited by 21 · see citing works
- Authors
- Shufelt, C. L., & Bairey Merz, C. N.
- Affiliations
- Cedars-Sinai Medical Center (US)
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2009-01
- Volume
- 53
- Issue
- 3
- Pages
- 221-231
- ISSN
- 0735-1097 (ISSN-L)
- PMC
- PMC2660203
- OpenAlex
- W2128055881
- Cited by
- 287
- References
- 92
- Citations by year
- 2026: 14 · 2025: 10 · 2024: 15 · 2023: 17 · 2022: 12 · 2021: 16 · 2020: 24 · 2019: 17 · 2018: 10 · 2017: 11 · 2016: 18 · 2015: 16 · 2014: 17 · 2013: 22 · 2012: 18
- FWCI
- 3.06
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (n01hv068164-006, n01hv068162-009, n01hv068161-005, n01hv068163-006)
- National Heart, Lung, and Blood Institute (N01-HV68162, N01 HV068162, N01HV68163, N01 HV068164, N01- HV-068161, N01 HV068163)
- National Center for Research Resources (MO1-RR00425, M01RR000425)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Keywords
- oral contraceptives, cardiovascular risk, hormone replacement therapy, atherosclerosis, thrombosis, venous thromboembolism, myocardial infarction, progestins, vaginal ring, cardiovascular risk assessment, Women's Health Initiative
- MeSH terms
- Adult, Age Factors, Animals, Cardiovascular Diseases, Contraceptives, Oral, Hormonal, Disease Models, Animal, Female, Humans, Middle Aged, Thromboembolism, United States, Cohort Studies, Incidence, Practice Guidelines as Topic, Premenopause, Postmenopause, Risk Assessment, Hormone Replacement Therapy
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