Gohlke-Bärwolf C
Rehabilitationszentrum für Herz- und Kreislaufkranke, Bad Krozingen.
Herz. 1987 Aug;12(4):263-75.
Oral contraceptives represent the most commonly employed means of contraception in the Federal Republic; they are used in 25% of all women in child-bearing age. The risk of myocardial infarction or cardiovascular death while taking oral contraceptives is determined primarily by three factors: the age of the user, the type and concentrations of estrogen and gestagen administered as well as the concomitant risk factors for coronary artery disease. With currently-used low-dose hormonal contraceptives, in young women (less than 30 years of age) who do not smoke and do not have other risk factors for coronary artery disease, there is no clear increase in the normally low risk of developing coronary artery disease or myocardial infarction. With increasing age and concomitant risk factors, users of hormonal contraceptives have an increased risk of myocardial infarction and cardiovascular death, where smoking has assumed a particularly important role. In general, the risk of cardiovascular death in users of oral contraceptives is approximately four-fold higher than in women who have never used oral contraception. A statistically-significant higher mortality has been documented in oral contraceptive users older than 35 years who smoke. In nonsmoking oral contraceptive users, the relative risk of myocardial infarction is 4.5. This increases to 23-fold for women who smoke more than 24 cigarettes daily. 75% of young women with myocardial infarction (under the age of 50 years) who use oral contraceptives, are smokers. Overall, the manifestation age of myocardial infarction is advanced four years through smoking alone, ten years through oral contraception alone and 13 years through the combination of smoking and oral contraception. The relevance of the duration of oral contraceptive use on the risk of infarction remains controversial. The number of young women with myocardial infarction and no or single-vessel coronary artery disease is significantly higher at 60% in women who have used oral contraceptives than in women of comparable age without oral contraceptive use (30%). The pathophysiological mechanism primarily responsible for myocardial infarction in oral contraceptive users and smokers appears to be thrombosis.
口服避孕药是联邦共和国最常用的避孕方式；25%的育龄妇女都在使用。服用口服避孕药时发生心肌梗死或心血管死亡的风险主要由三个因素决定：使用者的年龄、所服用雌激素和孕激素的类型及浓度，以及冠状动脉疾病的伴随风险因素。对于目前使用的低剂量激素避孕药，在不吸烟且无其他冠状动脉疾病风险因素的年轻女性（30岁以下）中，原本较低的患冠状动脉疾病或心肌梗死的风险并没有明显增加。随着年龄增长和伴随风险因素的出现，激素避孕药使用者发生心肌梗死和心血管死亡的风险增加，其中吸烟起到了尤为重要的作用。一般来说，口服避孕药使用者的心血管死亡风险比从未使用过口服避孕药的女性高约四倍。有统计数据表明，年龄超过35岁且吸烟的口服避孕药使用者死亡率显著更高。在不吸烟的口服避孕药使用者中，心肌梗死的相对风险为4.5。对于每天吸烟超过24支的女性，这一风险会增至23倍。使用口服避孕药的心肌梗死年轻女性（50岁以下）中，75%是吸烟者。总体而言，仅吸烟会使心肌梗死的发病年龄提前四年，仅服用口服避孕药会使其提前十年，而吸烟与口服避孕药同时使用则会使其提前13年。口服避孕药使用时长对梗死风险的相关性仍存在争议。使用过口服避孕药的女性中，患有心肌梗死且无冠状动脉疾病或单支血管冠状动脉疾病的年轻女性比例显著更高，为60%，而在未使用口服避孕药的同龄女性中这一比例为30%。口服避孕药使用者和吸烟者发生心肌梗死的主要病理生理机制似乎是血栓形成。
