WOMENS-HEALTH Messages for January, 1999: Oral contraceptives and heart disease

Oral contraceptives and heart disease

From: anne (anonymous@obgyn.net)
Wed, 20 Jan 1999 17:43:51 -0600 (CST)

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Hello my name is Anne Achen and I am a nursing student at the University of North Dakota. After reading several journal articles about oral contraceptives and heart disease, I found it interesting to hear about the risks and benefits of combined estrogen-progestin pills. The one area of particular interest was the effect of estrogen and progestin on HDL and LDL cholesterol levels. According to an article by Dr. R. Stan Williams (1992), estrogen causes a decrease in the level of LDL (the "bad" lipoprotein) and an increase in the level of HDL (the "good" lipoprotein) where as progestin has the opposite effect. In 1992, two new progestins, norgestimate and desogestrel, were found less likely to cause undesirable changes in lipid and lipoprotein metabolism (Hussar, 1993).

My concern was for the development of heart disease related to the effects of estrogen and progestin combination pills. Can a women with no risk for cardiovascular disease still develop it when taking BCPs for a long period of time (say 10 years)? Can a women also benefit from the BCPs that contain the norgestimate and desogestrel? Additionally, should she have her cholesterol check regularly even if no other risk factors exist?

According to a study done on postmenopausal women by the New England Journal of Medicine, the risk of major coronary heart disease decreased among women who took estrogen with progestin hormones (Grodstein, et al., 1996). Can a younger pre-menopausal women have the same decrease in risk when using combined BCPs?

Any information or thoughts on this subject would be greatly appreciated. Thanks for your time and consideration, Anne Achen College of Nursing student (University of North Dakota)

Grodstein, F., Stampfer, M.J., Manson, J.E., Colditz, G.A., Willett, W.C., Rosner, B., Speizer, F.E., & Hennekens, C.H. (1996). Postmenopausal estrogen and progestin use and the risk of cardiovascular disease. New England Journal of Medicine, (335)7, p.453-461.

Hussar, D.A. (1993). New drugs. Nursing, (23)5, p.57-64.

Williams, R.S. (1992). Benefits and risks of oral contraceptive use. Postgraduate-Medicine, (92)7, p. 155-157,161-162,168.

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