Resumen
Objetivo: Elucidar la relación entre el aumento del riesgo cardiovascular asociado al uso de anticonceptivos hormonales. Revisión bibliográfica: La anticoncepción hormonal es el método reversible más utilizado por las mujeres en todo el mundo para prevenir embarazos no planificados. Se clasifica en métodos combinados, que asocian estrógeno y progestágeno, y formulaciones a base de progestágeno solo. A lo largo de cuatro generaciones, los anticonceptivos han evolucionado con dosis hormonales reducidas para minimizar los efectos secundarios sin comprometer la eficacia anticonceptiva. Sin embargo, los riesgos cardiovasculares, como hipertensión, infarto agudo de miocardio, trombosis y accidente cerebrovascular, siguen siendo preocupaciones relevantes. Estos riesgos están asociados a los impactos hormonales en la función vascular, la inflamación y los procesos metabólicos. Consideraciones finales: A pesar de los numerosos beneficios ofrecidos por los anticonceptivos orales, como la prevención eficaz del embarazo y la regulación menstrual, es esencial evaluar cuidadosamente sus posibles riesgos cardiovasculares. Las investigaciones futuras son indispensables para mejorar las formulaciones hormonales y minimizar los efectos adversos, manteniendo sus ventajas clínicas.
Referencias
BASTOS M, et al. Combined oral contraceptives: venous thrombosis. Cochrane Database of Systematic Reviews, 2014; 3: 50.
BATUR P, et al. Contraception: Efficacy, risks, continuation rates, and use in high-risk women. Journal of women’s health, 2016; 25(8): 853–856.
BERTOLAMI MC. Warning against low-density lipoprotein oxidation in users of oral combined contraceptives. Arquivos brasileiros de cardiologia, 2018, 111(6): 771–771.
BHULLAR SK, et al. Oral hormonal contraceptives and cardiovascular risks in females. Canadian Journal of Physiology and Pharmacology, 2024; 102: 572–584.
BRITO MB, et al. Contracepção Hormonal e Sistema Cardiovascular. Arquivo Brasileiro de Cardiologia, 2011; 96: 81-89.
BURKMAN R, et al. The evolution of combined oral contraception: improving the risk-to-benefit ratio. Elsevier, 2011; 84: 19-34.
CAGNACCI A. Hormonal contraception: venous and arterial disease. The European Journal of Contraception & Reproductive Health Care, 2017; 22: 191-199.
CORREIA P, et al. Ischemic stroke on hormonal contraceptives: Characteristics, mechanisms and outcome. European Stroke Journal, 2021; 6(2): 205–212.
FABUNMI OA, et al. Investigating cardiovascular risk in premenopausal women on oral contraceptives: Systematic review with meta-analysis. Frontiers in Cardiovascular Medicine, 2023; 10: 1127104.
FEHR A, et al. Cardiovascular Risks of Combined Oral Contraceptive Use. American Family Physician, 2012; 86: 12.
FERREIRA LF, et al. O uso da pílula anticoncepcional e as alterações das principais vias metabólicas. Femina, 2019; 47(7): 426-432.
GIRIBELA CRG, et al. Effect of a low-dose oral contraceptive on venous endothelial function in healthy young women: Preliminary results. Clinics, 2007; 62(2): 151–158.
GIUSEPPE MC, et al. Obesity and contraceptive use: impact on cardiovascular risk. ESC Heart Failure, 2022; 9: 3761–3767.
HASSAN R, et al. Female sex-specific and -predominant cardiovascular risk factors and heart failure practice guidelines. American heart journal, 2022; 247: 63–67.
KASAL DAB e LORENZO A. Oral Contraceptives and Cardiovascular Risk: Adding Clinical Evidence to the Pathophysiology. International Journal of Cardiovascular Sciences, 2020; 33(3): 215-216.
LIMA ACS, et al. Influence of hormonal contraceptives and the occurrence of stroke: integrative review. Revista brasileira de enfermagem, 2017; 70(3):647–655.
LIMA FMT, et al. Hormonal contraceptives: interactions that can Commit your effectiveness. Brazilian Journal of Health Review, 2021; 4: 27708-27720.
MACHADO F, et al. Anticoncepcionais orais combinados e aspectos clínicos. Research, Society and Development, 2022; 11(14): 96111436097.
PASSOS EP, et al. Rotinas em Ginecologia. 7ed. Porto Alegre; Artmed Editora Ltda, 2017; 1074.
PELIN B, et al. Contraception: Efficacy, Risks, Continuation Rates, and Use in High-Risk Women, 2016. Journal of Women's Health, 2002; 25(8): 853–856.
REGIDOR PA. Clinical relevance in present day hormonal contraception. Hormone Molecular Biology and Clinical Investigation, 2018; 37: 20180030.
RIVERA R, et al. The mechanism of action of hormonal contraceptives and intrauterine contraceptive devices, 1999; 181: 1263-1269.
TEIXEIRA AC, et al. Aspectos atuais da avaliação do dispositivo intrauterino (DIU) pelos métodos de imagem e suas principais intercorrências. Brazilian Journal of Health Review, Curitiba, 2022; 5(1): 1536-1552.
TRINH A, et al. Contraception and Cardiovascular Effects: What Should the Cardiologist Know? Women and cardiovascular health, 2023; 25: 1489–1498.
