عوارض قلبی عروقی قرصهای ضد بارداری خوراکی

SUMMARY Cardiovascular complication of oral contraceptives Mohammad Reza Afraz M.D. cardiologist Assistant professor, Gilan university of medical sciences, Rasht. Soon after the introduction of oral contraceptive agents in 1960, the potential risks of cardiovascular disease became apparent. Most investigators agree that there is an increased incidence of hypertension, myocardial infarction, cerebrovascular accidents, and thromboem bolic disease in users of oral contraceptives. The use of oral contraceptive agents not only increases these risks but also in the presence of other risk factors multiplies the chances of certain cardiovascular complications . The relative risk of thrombophlebitis or pulmonary embolism in oral contraceptive users is 2 to 11 times that of nonusers, representing a significant morbidity rate but rare death . this effect is thought to result from an increase in coagulability and antisteroid hormone antibodies caused by these agents. Myocardial infarctions are extremely rare events in women ingesting oral contraceptives and are usually limited to women over the age of 35 years who smoke or Women who are hypertensive, diabetic, or have a history of toxemia have a higher rate of myocardial infarction." The cause of myocardial infarction in oral contraceptive users is thrombotic and not atherosclerotic. The risk of stroke is also strongly affected by the presence of other factors. Factors which increase the chances of this complication include hypertension, smoking, migraine headaches, hypercholesterolemia, and possibly mitral valve prolapse. The majority of users will have a mild elevation, and 5 percent will have significant rise in blood pressure, representing an incidence 2 to 3 times that of nonusers. In most cases the hypertension is mild to moderate and reversible after discontinuing . A few instances of malignant hypertension have been reported. The effects of these agents on the renin angiotensin system and sodium metabolism are possible mechanisms of the hypertension. Despite the increased risk of vascular disease, a normal young woman who uses oral contraceptives is at a very small risk of thromboembolism, stroke, myocardial infarction or arterial hypertension. In general , the cardiovascular effects of the oral contrac eptives might possibly be minimized by advising women to consider alternative methods of contraception if ( 1 ) they have had previous thromboembolic disorders (phlebitis, pulmonary embolism, stroke, or myocardial infarction); (2) they show preminent risk factors for thromboembolic disorders including severe varicose veins, heavy cigarette smoking, blood dyscrasias, hypertension, and possibly diabetes mellitus ; and (3) they are 35 years of age or older and are cigarette smokers who choose not to stop smoking.