Hormonal Contraception in Women With Hypertension

Shufelt, Chrisandra; LeVee, Alexis

doi:10.1001/jama.2020.11935

Cited by 29 publications

(31 citation statements)

References 10 publications

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“…If BP remains stable after a few months, OCP may be continued. 243 Use of OCP is contraindicated in women older than 35 years who smoke, have severe dyslipidaemia, or obesity. 244 Progestin-only contraceptives (POCs) are not associated with increased vascular risk (arterial or venous), although evidence suggests that MPA use may be associated with a slightly increased risk.…”

Section: Contraception In Women At High Cardiovascular Disease Riskmentioning

confidence: 99%

Cardiovascular health after menopause transition, pregnancy disorders, and other gynaecologic conditions: a consensus document from European cardiologists, gynaecologists, and endocrinologists

Maas

Rosano

Cífková

et al. 2021

European Heart Journal

178

128

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Women undergo important changes in sex hormones throughout their lifetime that can impact cardiovascular disease risk. Whereas the traditional cardiovascular risk factors dominate in older age, there are several female-specific risk factors and inflammatory risk variables that influence a woman’s risk at younger and middle age. Hypertensive pregnancy disorders and gestational diabetes are associated with a higher risk in younger women. Menopause transition has an additional adverse effect to ageing that may demand specific attention to ensure optimal cardiovascular risk profile and quality of life. In this position paper, we provide an update of gynaecological and obstetric conditions that interact with cardiovascular risk in women. Practice points for clinical use are given according to the latest standards from various related disciplines (Figure 1).

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Section: Contraception In Women At High Cardiovascular Disease Riskmentioning

confidence: 99%

Cardiovascular health after menopause transition, pregnancy disorders, and other gynaecologic conditions: a consensus document from European cardiologists, gynaecologists, and endocrinologists

Maas

Rosano

Cífková

et al. 2021

European Heart Journal

178

128

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“…38,39 The metabolism of the synthetic estrogens can cause BP to rise, and normotensive women taking OCPs can have up to a 7 to 8 mm Hg increase in BP. 40 Within the first year of use, risk of venous thromboembolism (VTE) is increased among OCP users (3–9/10 000 woman-years) compared with nonusers (1–5/10 000 woman-years). 41 Similar to elevations in BP, this increased VTE risk is attributed to the synthetic estrogens within the pills.…”

Section: Contraception and Cvd Riskmentioning

confidence: 99%

Pregnancy and Reproductive Risk Factors for Cardiovascular Disease in Women

O’Kelly

Michos

Shufelt

et al. 2022

Circulation Research

138

121

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Beyond conventional risk factors for cardiovascular disease, women face an additional burden of sex-specific risk factors. Key stages of a woman’s reproductive history may influence or reveal short- and long-term cardiometabolic and cardiovascular trajectories. Early and late menarche, polycystic ovary syndrome, infertility, adverse pregnancy outcomes (eg, hypertensive disorders of pregnancy, gestational diabetes, preterm delivery, and intrauterine growth restriction), and absence of breastfeeding are all associated with increased future cardiovascular disease risk. The menopause transition additionally represents a period of accelerated cardiovascular disease risk, with timing (eg, premature menopause), mechanism, and symptoms of menopause, as well as treatment of menopause symptoms, each contributing to this risk. Differences in conventional cardiovascular disease risk factors appear to explain some, but not all, of the observed associations between reproductive history and later-life cardiovascular disease; further research is needed to elucidate hormonal effects and unique sex-specific disease mechanisms. A history of reproductive risk factors represents an opportunity for comprehensive risk factor screening, refinement of cardiovascular disease risk assessment, and implementation of primordial and primary prevention to optimize long-term cardiometabolic health in women.

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“…Instead, we assessed death, revascularization, and shock, which represent severe complications of myocardial infarction. The impact of hormonal replacement therapy on the clinical outcome was not assessed 24,25 …”

Section: Limitationsmentioning

confidence: 99%

Sex difference in long‐term clinical outcomes after percutaneous coronary intervention: A propensity‐matched analysis of National Health Insurance data in Republic of Korea

Lee

Choi

Chang

et al. 2021

Cathet Cardio Intervent

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Objective We investigated the gender difference in the 5‐year outcome after percutaneous coronary intervention (PCI) using an unselected population data. Background Sex‐specific outcome after percutaneous coronary intervention (PCI) is not consistent among studies. Methods A total of 48,783 patients were enrolled from a Korean nationwide cohort of PCI in year 2011. Outcomes adjusted with age and propensity for clinical characteristics were compared. Primary outcome was 5‐year cumulative incidence of all‐cause death. Nonfatal major adverse clinical event (MACE) consisting of revascularization, shock, or stroke was also assessed. Results In unadjusted analysis, women were older and had higher frequency of comorbidities including hypertension, hyperlipidemia, and diabetes compared to men (p < .001, all). Women had higher 5‐year death risk than men (21.8 vs. 17.3%; hazard ratio [HR] 1.29, 95% confidential interval [CI] 1.23–1.34). In propensity score‐matched analysis (N = 28,924), women had lower 5‐year death risk (20.2 vs. 26.1%, HR 0.75, 95% CI 0.71–0.78). This lower death risk in women was consistent in subgroup analyses of age, risk factors, and clinical diagnosis including angina or acute myocardial infarction (p < .05, all). Conclusions Older age and more common comorbidities in women contributed to the apparent worse outcome after PCI in women. After adjusting these disadvantages, women had better outcome after PCI than men.

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Hormonal Contraception in Women With Hypertension

Cited by 29 publications

References 10 publications

Cardiovascular health after menopause transition, pregnancy disorders, and other gynaecologic conditions: a consensus document from European cardiologists, gynaecologists, and endocrinologists

Cardiovascular health after menopause transition, pregnancy disorders, and other gynaecologic conditions: a consensus document from European cardiologists, gynaecologists, and endocrinologists

Pregnancy and Reproductive Risk Factors for Cardiovascular Disease in Women

Sex difference in long‐term clinical outcomes after percutaneous coronary intervention: A propensity‐matched analysis of National Health Insurance data in Republic of Korea

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