The scientific literature is mixed regarding contraceptives and cardiovascular risk. Some studies indicate that oral contraceptives can elevate specific vascular or stroke risks, particularly when combined with other predisposing factors like genetic risk or smoking, while other studies conclude that modern low-dose contraceptives do not increase the risk of heart disease in healthy populations.
BackgroundOral contraceptives (OCs) are generally safe but vascular risk factors increase OC-associated ischemic stroke risk. We performed a case-control study to evaluate whether a genomic risk score for ischemic stroke modifies OC-associated ischemic stroke risk.MethodsThe Genetics of Early-Onset Stroke study includes 332 premenopausal women (136 arterial ischemic stroke cases and 196 controls) with data on estrogen-containing OC use within 30 days before the index event (for cases) or interview (for controls). Using a previously validated genetic risk score (metaGRS) for ischemic stroke based on 19 polygenic risk scores for stroke and stroke-associated risk factors, we stratified our combined case-control sample into tertiles of genomic risk. We evaluated the association between OC use and ischemic stroke within each tertile. We tested if the association between OC use and ischemic stroke depended on the genomic risk of stroke using logistic regression with an OC use × metaGRS interaction term. These analyses were performed with and without adjustment for smoking, hypertension, diabetes, coronary heart disease, and body mass index.ResultsAfter adjustment for vascular risk factors, the odds ratio of OC use was 3.2 (1.7–6.3) overall and increased from the lower, middle, and upper tertile of genomic risk from 1.6 (0.5–5.4) to 2.5 (0.08–8.2) to 13.7 (3.8–67.3) respectively, and a p-value for interaction of 0.001.ConclusionsOur results suggest that genomic profile may modify th
The risk factors for cardiovascular disease are related directly or indirectly in women, as in men, to lipid and lipoprotein levels. But women have the advantage of the beneficial effects of either endogenous or exogenous estrogen on these levels throughout most of their lives. Behaviors such as smoking or diseases such as diabetes interfere with the favorable lipid and lipoprotein levels seen in women, and heart disease risk is increased significantly. Oral contraceptives have negative effects on lipids but appear not to increase risk for atherosclerosis in current or past users. Postmenopausal estrogen therapy appears to protect women from heart disease, but the long-term effect on risk is unknown for combination hormone therapy. The monitoring of a women's lipid profile, a major indicator of risk for heart disease, is of paramount importance.
Because of the elevated risk of pathological problems for women over 35 the recommendation for an oral contraceptive (OC) must be carefully considered after the physician has studied the individuals health history and assessed the risks. The physician is responsible for understanding specific needs of each patient as well as understanding risks inherent with the aging process of the female population such as an increased risk of diabetes a rise in weight and blood pressure and an increased risk of heart disease. The administration of exogenous hormones and the affect of these hormones pertaining to each of the risk areas is studied. Studies concluding that estrogen deficiency is related to hypertension risk seem to support the assumption that estrogens counteract the development of hypertension. However other studies have shown an increase in the incidence of hypertension following OC intake. Exogenous hormones have not been linked to an increase in the volume of fat cells. Oral contraceptives do not increase the risk of diabetes if there is no genetic disposition to the disease; patients who do show evidence of the existing disease should be carefully monitored. A further conclusion is that oral contraceptives have a minimal affect on blood clotting. The most effective way to limit health hazards is by limiting the dosage and the frequency of hormonal contraceptives. With careful medical supervision older women can be open to alternative methods of contraception including or
Case control studies of oral contraceptives in the literature proved an increasing risk of cardiovascular diseases ranged from 2 to 6. In the presented GDR-case-control-study 425 women with cardiovascular diseases and 1,275 controls without cardiovascular diseases have been entered. Cases and controls were examined in ten centers. We found no elevated risk for ischemic heart disease, cerebrovascular disease, and hypertonic heart disease in oral contraceptive users. The risk did not depend on age, type of oral hormonal contraceptive, and duration of use. There was only a statistical significant increase in the estimated relative risk of 2.05 in venous thrombosis and thrombophlebitis. Of course, prudent medical practice requires that a possible risk of certain cardiovascular events during hormonal contraceptive use must be taken into account when weighting the risks and benefits of each patient's contraceptive choices. Further studies are needed.
During 1965-9 22 women aged 41 years or less have been seen with myocardial infarction. Eleven had been taking oral contraceptives. This prevalence of oral contraception (50%) is appreciably greater than that estimated for women of the same age in the general population. Nine of these 11 women had an independent increased risk of developing ischaemic heart disease because of hyperlipidaemia, hypertension, or excessive cigarette smoking. Ten of the 11 not taking an oral contraceptive also had a readily identifiable predisposing factor. None of the 22 showed carbohydrate intolerance. The similarity of the two groups is the striking finding. Details of 15 women of comparable age seen during 1960-4 before oral contraceptives were widely used are also presented, and they had similar characteristics. Oral contraceptives do not appear on their own to increase the risk of developing myocardial infarction, but they may do so in women otherwise prone to ischaemic heart disease. Suggestions are made for the identification of these women.
Coronary heart disease is the leading cause of death among women. Reported risk factors for women are smoking, use of oral contraceptives, diabetes, elevated blood pressure, elevated blood lipids, low socio-economic status, low educational attainment, Type A behaviour and chronic troubling emotions. Via an on-line literature search (Medline and Psychlit) all case-control and prospective studies of coronary heart disease risk factors in women have been collected from 1978 to 1993. Smoking remains the most prominent risk factor for myocardial infarction in young women, the risk increasing significantly with the amount of cigarettes smoked. Use of modern low-dose oral contraceptives in healthy, non-smoking women does not increase the risk. Oestrogen replacement therapy seems to protect against coronary heart disease, although the reduction in risk may have been over-estimated. Elevated cholesterol and elevated blood pressure are major risk factors, and diabetes seems to have a stronger impact on risk in women than in men. Low socio-economic class is a stronger risk factor for women than for men and the double loads of career and family seem to increase risk for women.
Everything we examined (6)
This check searched the claim as stated. It did not run a separate search for evidence against it.