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  • Title: Cardiovascular disease: pathogenesis, epidemiology, and risk among users of oral contraceptives who smoke.
    Author: Castelli WP.
    Journal: Am J Obstet Gynecol; 1999 Jun; 180(6 Pt 2):S349-56. PubMed ID: 10368520.
    Abstract:
    Smoking increases the risk of lung cancer and cardiovascular disease among persons of both sexes. The risk of cardiovascular disease is further increased among users of oral contraceptives who smoke, particularly those who are >/=35 years old or carry the coagulation factor V Leiden mutation. Other important cardiovascular disease risk factors in women include waist/hip girth ratio >0.8, high concentration of low-density lipoprotein cholesterol (>115 mg/dL), high triglyceride level (>/=150 mg/dL) with low concentration of high-density lipoprotein cholesterol (</=45 mg/dL), high ratio of total cholesterol/high-density lipoprotein (4.0), high ratio of low-density lipoprotein/high-density lipoprotein (3.0), glucose values >/=100 mg/dL, hypertension, lack of physical activity, and high-fat diet. Most excess cardiovascular disease among users of oral contraceptives is due to thrombosis (not atherosclerosis); studies indicate that the lower the oral contraceptive estrogen dose is, the lower is this risk. Oral contraceptives containing the third-generation progestins desogestrel and gestodene have been associated with greater risks of venous thromboembolism than are associated with older progestins, although there is some controversy surrounding these findings. This paper examines the pathogenesis, epidemiology and risk of cardiovascular disease due to smoking and oral contraceptive (OC) use among women. The major risks associated with smoking were cardiovascular diseases and lung cancer. Characteristics of a syndrome which significantly increases the cardiovascular disease risk include: waist/hip girth ratio 0.8, glucose concentration 100 mg/dl, insulin 25 mU/l, peptide C 1.3 nmol/l, blood pressure 135/85 mm Hg, high triglyceride level 150 mg/dl with low concentration of HDL cholesterol (45 mg/d), total cholesterol/HDL ratio 4.0, LDL cholesterol (small dense pattern B) 130 mg/dl, uric acid concentration 7 mg/dl, and microalbuminuria 30-200 mg/dl. Women users over age 35 carrying the coagulation factor V Leiden mutation were found to be at increased risk of death from cardiovascular disease. The study indicates that increasing the estrogen dosage in an OC from 20 to 50 mcg ethinyl estradiol produced greater risks. Most cardiovascular disease among OC users is due to thrombosis. OCs containing the third-generation progestins desogestrel and gestodene have been associated with greater risks of venous thromboembolism that are associated with older progestins, although there is some controversy surrounding these findings. Smokers must be discouraged. When middle-aged women stopped smoking, about a third of their excess risk for coronary heart disease was eliminated within 2 years of cessation, and their risk became similar to that of nonsmoking women within 10-14 years.
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