Vascular Dynamics Laboratory, Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada.
Am J Physiol Heart Circ Physiol. 2021 Jan 1;320(1):H77-H89. doi: 10.1152/ajpheart.00614.2020. Epub 2020 Nov 8.
Hormonal contraceptives are one of the most widely used prescriptions for premenopausal women worldwide. Although the risk of venous and arterial cardiovascular events (e.g., deep vein thrombosis, arterial clotting) with hormonal contraceptives, specifically oral contraceptive pills, has been established, the literature on early risk indicators, such as peripheral vascular structure and function has yet to be consolidated. The purpose of this review is to summarize literature examining the impact of different hormonal contraceptives on vascular function and structure, including consideration of phasic differences within a contraceptive cycle, and to propose future directions for research. It is evident that hormonal contraceptive use appears to impact both macrovascular and microvascular endothelial function, with phasic differences in some contraceptive types dependent on progestin type, the ratio of ethinyl estradiol-to-progestin, and route of administration. However, hormonal contraceptives do not appear to impact smooth muscle function in the macrovasculature or microvasculature, arterial stiffness, or vascular structure. Underlying mechanisms for observed impacts and areas of future research are discussed. This review provides timely consolidation of research examining hormonal contraceptives and peripheral vascular function and structure and provides guidance on considerations for hormonal contraceptive use in study design.
激素避孕药是全球绝经前女性最广泛使用的处方之一。尽管已经确定激素避孕药（特别是口服避孕药）与静脉和动脉心血管事件（例如深静脉血栓形成、动脉血栓形成）的风险有关，但关于外周血管结构和功能等早期风险指标的文献尚未得到整合。本综述的目的是总结研究不同激素避孕药对血管功能和结构影响的文献，包括考虑避孕药周期内的时相差异，并为未来的研究提出方向。显然，激素避孕药的使用似乎会影响大血管和微血管内皮功能，某些避孕药类型的时相差异取决于孕激素类型、炔雌醇与孕激素的比例和给药途径。然而，激素避孕药似乎不会影响大血管或微血管中的平滑肌功能、动脉僵硬度或血管结构。讨论了观察到的影响的潜在机制和未来研究领域。本综述及时整合了研究激素避孕药与外周血管功能和结构的文献，并就研究设计中激素避孕药使用的注意事项提供了指导。
