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Windisch S, Frishman WH. Thrombotic and Vascular Complications of Oral Contraceptives. Cardiol Rev 2024:00045415-990000000-00196. [PMID: 38230942 DOI: 10.1097/crd.0000000000000643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
The oral contraceptive pill is the most commonly used form of reversible contraception, as it has significantly grown in popularity in recent years. The 2 types of oral contraceptive pills are combination oral contraceptives, which contain estrogen and progesterone, and progestin-only pills. Both have failure rates of approximately 7.2-9% with typical use and are safe for most patients. However, several thrombotic and vascular complications have been found to be associated with the usage of oral contraceptive pills, most notably being an increase in blood pressure and thrombosis. Although these complications do not typically affect young, healthy females, they merit concern for patients with a history of hypertension or thrombosis or patients with preexisting risk factors for these conditions. Overall, progestin-only pills are the safer option regarding these complications. Additionally, a complete summary of the medical eligibility criteria for contraceptive use has been created and is regularly updated by the Centers for Disease Control and Prevention. This chart summarizes the recommendations for contraception use by patients with a variety of preexisting conditions or risk factors.
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Affiliation(s)
- Stephen Windisch
- From the Departments of Medicine and Cardiology, New York Medical College/Westchester Medical Center, Valhalla, NY
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2
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He Z, Wen X, Zhou L. Reproductive health factors in relation to risk of hypertension in postmenopausal women: Results from NHANES 2011-2014. Medicine (Baltimore) 2023; 102:e35218. [PMID: 37713823 PMCID: PMC10508507 DOI: 10.1097/md.0000000000035218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 08/23/2023] [Indexed: 09/17/2023] Open
Abstract
Few studies have systematically assessed the relationship between multiple reproductive factors and hypertension, and these limited studies paid more attention to age at menarche and menopause, abortion, or the number of live births, and yielded controversial results. This study aimed to explore the relationship between reproductive health factors and hypertension from 5 aspects: history of menstruation, pregnancy, delivery, gynecological surgery, and reproductive-related medication use. We analyzed data from the National Health and Nutrition Examination Survey 2011 to 2014. Data on reproductive factors were collected using a questionnaire survey. The associations between multiple reproductive factors and the risk of hypertension were assessed using multivariable logistic regression models. There were significant inverse associations between age at menopause (odds ratio [OR] = 0.984, 95% confidence interval [CI]: 0.971-0.998, P = .0234 per 1-year increase), age at first live birth (OR = 0.970, 95% CI: 0.944-0.998, P = .0346 per 1-year increase), age at last live birth (OR = 0.982, 95% CI: 0.964-0.999, P = .0488 per 1-year increase), and the risk of hypertension. In contrast, a positive association was found between the risk of hypertension and a history of gestational diabetes (OR = 1.693, 95% CI: 1.042-2.751, P = .0333), hysterectomy (OR = 1.398, 95% CI: 1.139-1.717, P = .0014), ovariectomy (OR = 1.374, 95% CI: 1.074-1.758, P = .0115), and birth control pill use (OR = 1.293, 95% CI: 1.035-1.616, P = .0236). Age at menopause but not menarche, is inversely associated with hypertension. A history of gestational diabetes, hysterectomy, ovariectomy, or birth control pills was associated with a higher risk of hypertension.
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Affiliation(s)
- Zehao He
- School of Clinical Medicine, Chengdu Medical College, Chengdu, China
| | - Xiaoxiao Wen
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL
| | - Long Zhou
- Institute of Cardiovascular Diseases & Department of Cardiology, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Cameron NA, Blyler CA, Bello NA. Oral Contraceptive Pills and Hypertension: A Review of Current Evidence and Recommendations. Hypertension 2023; 80:924-935. [PMID: 37075131 PMCID: PMC10852998 DOI: 10.1161/hypertensionaha.122.20018] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Oral contraceptive pills (OCPs) have been used as effective and popular forms of contraception since the middle of the last century. By 2019, over 150 million reproductive-aged individuals were using OCPs to prevent unintended pregnancies worldwide. Safety concerns regarding the effects of OCPs on blood pressure were reported soon after these pills gained approval. Although OCP doses were subsequently reduced, epidemiologic evidence continued to support a smaller, but significant association between OCPs and hypertension. Given the rising prevalence of hypertension, as well as the adverse effects of cumulative exposure to blood pressure elevations on cardiovascular disease risk, understanding the nature of the association between OCPs and hypertension is important for clinicians and patients to assess the risks and benefits of use, and make individualized decisions regarding contraception. Therefore, this review summarizes the current and historical evidence describing the association between OCP use and blood pressure elevations. Specifically, it identifies the pathophysiologic mechanisms linking OCPs to hypertension risk, describes the magnitude of the association between OCPs and blood pressure elevations, and distinguishes the effects of various OCP types on blood pressure. Finally, it describes current recommendations regarding hypertension and OCP use, as well as identifies strategies, such as over-the-counter OCP prescribing, to safely and equitably improve access to oral contraception.
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Affiliation(s)
- Natalie A Cameron
- Northwestern University Feinberg School of Medicine, Department of Medicine, Division of General Internal Medicine, Chicago, Illinois
| | - Ciantel A. Blyler
- Department of Cardiology Smidt Heart Institute Cedars-Sinai Medical Center, Los Angeles, California
| | - Natalie A Bello
- Department of Cardiology Smidt Heart Institute Cedars-Sinai Medical Center, Los Angeles, California
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Sinha R, Maheshwari S, Gupta P, Roy D, Deepshikha .. Socio-economic Correlates of Body Mass Index, Blood Pressure and Contraceptive Use by Reproductive age-group Females. INDIAN JOURNAL OF COMMUNITY HEALTH 2022. [DOI: 10.47203/ijch.2022.v34i02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background: Oral Contraceptive use, BP and BMI are strongly associated variables in terms of socio economic conditions. Oral Contraceptives are an important and widely accepted contraceptive modality used throughout the world. Aim & Objective: This study aims to examine the effects of socio-economic factors on Body Mass Index (BMI), Blood pressure (BP) and contraceptive use by reproductive age-group females of Uttarakhand. Settings and Design: This study utilizes nationwide data from the Fourth National Family Health Survey (NFHS-IV). Methods and Material: Information was collected from Indian Institute of Population Sciences (IIPS) Mumbai and 17,300 women of Uttarakhand were considered for this study. Statistical analysis used: For inter age-group comparisons of blood pressure, BMI and socio-demographic indicators, analysis of variance (ANOVA) technique has been used. Results: The variation in mean age at menarche was found to be significant (p< 0.01, ANOVA). The numbers of live births over the women's total lifetime were lower in the younger age groups (p<0.01, ANOVA). Conclusions: The important findings of present study were that the use of contraceptive tended to have increased BMI and elevated blood pressure, even though the magnitude of these was little (equal to 4% and 40% respectively).
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Tang N, Ma J, Tao R, Chen Z, Yang Y, He Q, Lv Y, Lan Z, Zhou J. The effects of the interaction between BMI and dyslipidemia on hypertension in adults. Sci Rep 2022; 12:927. [PMID: 35042940 PMCID: PMC8766602 DOI: 10.1038/s41598-022-04968-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 01/05/2022] [Indexed: 12/04/2022] Open
Abstract
Body mass index (BMI) and dyslipidemia are indicators of human health and are often associated with high blood pressure. In this study,we explored the relationship between BMI or dyslipidemia and the risk of hypertension and further verified the possible interacting influences of BMI with dyslipidemia on the risk of hypertension. The aim is to explore the possible risk factors of hypertension and to provide scientific basis for the prevention and treatment of hypertension. Eligible subjects were selected from a cross-sectional survey in Changsha City, and we collected relevant data and clinical indicators for each participant. Body mass index (BMI) was calculated as weight (kg)/height2 (m2), and divided into four categories according to the Chinese standard. Dyslipidemia is defined according to Chinese guideline. Unconditional logistic regression models were used for dichotomous variables to determine the risk or protective factors of dependent variables. Multivariate Logistic model was used to study the influence of BMI and dyslipidemia on hypertension. The following indicators were used to assess the interaction effects: (1) Relative excess risk due to interaction (RERI); (2) Attributable proportion due to interaction(AP); (3) Synergy index (SI). SPSS software was used for statistical analysis. A total of 2740 eligible participants were enrolled in the cross-sectional study, of which 765 subjects (27.9%) were diagnosed with hypertension. Multivariate Logistic model showed that overweight (OR: 1.70, 95%CI: 1.39–2.09) or obese (OR: 2.60, 95%CI: 1.84–3.66) subjects had a significantly higher risk of hypertension than normal weight people, and underweight was a protective factor for hypertension(OR: 0.52, 95%CI: 0.29–0.93). People with dyslipidemia have a higher risk of hypertension than those with normal lipids (OR: 3.05, 95%CI: 2.36–3.90). In addition,there was a significant potentiating interaction effect between overweight or obesity and dyslipidemia(overweight: RERI (1.91, 95%CI: 0.17–3.66), AP (0.40, 95%CI:0.14–0.66), SI (2.03, 95%CI:1.11–3.74) and obesity: RERI (2.20, 95%CI:1.01–3.40), AP (0.38, 95%CI:0.18–0.58), SI (1.84, 95%CI:1.18–2.89), while no interaction was found between underweight and dyslipidemia. Low body weight is an independent protective factor for hypertension, but overweight, obesity and dyslipidemia are risk factors for hypertension, and dyslipidemia significantly shared interactions with overweight and obesity that influenced the risk of hypertension.
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Affiliation(s)
- Na Tang
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, 410013, Hunan, China
| | - Jian Ma
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, 410013, Hunan, China
| | - Rongqin Tao
- Tianxin District Center for Disease Control and Prevention, Changsha, 410009, Hunan, China
| | - Zhijun Chen
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, 410013, Hunan, China
| | - Yide Yang
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, 410013, Hunan, China
| | - Quanyuan He
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, 410013, Hunan, China
| | - Yuan Lv
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, 410013, Hunan, China
| | - Zelong Lan
- Tianxin District Center for Disease Control and Prevention, Changsha, 410009, Hunan, China.
| | - Junhua Zhou
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, 410013, Hunan, China.
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Jimoh OS, Abdul IF, Balogun OR, Biliaminu SA, Adeniran AS, Jimoh-Abdulghaffaar HO, Adesina KT, Ahmed A, Oladosu WO. Atherogenic and cardiovascular risks of women on combined oral contraceptives: A comparative study. Niger J Clin Pract 2021; 24:1759-1765. [PMID: 34889782 DOI: 10.4103/njcp.njcp_431_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Although combined oral contraceptive (COC) is commonly used in sub-Saharan Africa, data on its cardiovascular disease risk remains scanty. The study aimed to determine serial serum lipid profiles and cardiovascular disease risks among COC-users. Methods This is a prospective, comparative multicentered study conducted at four health facilities in Nigeria. Participants were new users of contraceptives; 120 each of women initiating COCs (group I) and those initiating other forms of nonhormonal contraceptives (group II) were recruited and monitored over a 6-month period. Serial lipid profile, blood pressure, and atherogenic risk for cardiovascular diseases were measured at recruitment (start) and scheduled follow-up clinic visits at 3 months and 6 months for all participants. Statistical analysis was performed with SPSS (version 21.0) and P value < 0.05 was considered significant. Results In all, 225 participants (111 COC-users, 114 nonCOC-users) that completed the study were aged 18 to 49 years. There was a statistically significant increase in the diastolic blood pressure (P = 0.001), Low Density Lipoprotein- Cholesterol (P = 0.038) and higher atherogenic risk (P = 0.001) among COC-users compared to nonCOC-users. The serial total serum cholesterol, triglyceride, High Density Lipoprotein, systolic blood pressure, and body mass index were higher among COC-users but were not statistically significant compared to nonCOC-users. Conclusion Alterations in lipid profile and increased short-term atherogenic risk for cardiovascular disease were reported among the COC-users in this study. Serial lipid profile and atherogenic risk assessment for cardiovascular diseases are recommended for monitoring of COC-users.
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Affiliation(s)
- O S Jimoh
- Department of Obstetrics and Gynaecology, Federal Medical Centre, Abeokuta, Nigeria
| | - I F Abdul
- Department of Obstetrics and Gynaecology, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - O R Balogun
- Department of Obstetrics and Gynaecology, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - S A Biliaminu
- Department of Chemical Pathology, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - A S Adeniran
- Department of Obstetrics and Gynaecology, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | | | - K T Adesina
- Department of Obstetrics and Gynaecology, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - A Ahmed
- Department of Community Medicine and Primary Care, Federal Medical Centre, Abeokuta, Nigeria
| | - W O Oladosu
- Department of Chemical Pathology, Federal Medical Centre, Abeokuta, Nigeria
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Afshari M, Alizadeh-Navaei R, Moosazadeh M. Oral contraceptives and hypertension in women: results of the enrolment phase of Tabari Cohort Study. BMC Womens Health 2021; 21:224. [PMID: 34049551 PMCID: PMC8161571 DOI: 10.1186/s12905-021-01376-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 05/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The association between oral contraceptives (OCP) and hypertension has been reported in the literature with controversial results. According to the growing use of OCPs among women in Iran, this study aims to investigate the association between the duration of the OCP consumption and risk of hypertension among Iranian women. METHODS In the current study, the data collected during the enrolment phase of the Tabari cohort were analyzed. Of 6106 women recruited in the cohort, 133 pregnant women were excluded. Epidemiological variables were collected using pre-designed questionnaires as well as the health insurance evidences. In addition, blood pressure and anthropometric factors were measured based on the standard guidelines. Chi square and partial correlation tests as well as logistic regression models were applied for data analysis. RESULTS Frequency of oral contraceptive use among 35-70 year-old women in Tabari cohort study (TCS) was 42.2% (2520/5973). Hypertension was observed among 25% (1793/5973) of them. The adjusted odds ratio for OCP use was 1.23 (95% confidence interval: 1.08, 1.40, p = 0.002). The corresponding odds ratios for 61-120 months and more than 120 months OCP use were 1.39 (1.12,1.73) and 1.47 (1.16,1.87) respectively. CONCLUSIONS Oral contraceptives especially in long term use can be associated with hypertension.
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Affiliation(s)
- Mahdi Afshari
- Pediatric Gastroenterology and Hepatology Research Center, Zabol University of Medical Sciences, Zabol, Iran
| | - Reza Alizadeh-Navaei
- Gastrointestinal Cancer Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahmood Moosazadeh
- Gastrointestinal Cancer Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.
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Bakesiima R, Byakika-Kibwika P, Tumwine JK, Kalyango JN, Nabaasa G, Najjingo I, Nabaggala GS, Olweny F, Karamagi C. Dyslipidaemias in women using hormonal contraceptives: a cross sectional study in Mulago Hospital Family Planning Clinic, Kampala, Uganda. BMJ Open 2018; 8:e022338. [PMID: 30341126 PMCID: PMC6196835 DOI: 10.1136/bmjopen-2018-022338] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To determine the prevalence and factors associated with dyslipidaemias in women using hormonal contraceptives. DESIGN Cross-sectional study SETTING: Mulago Hospital, Kampala, Uganda PARTICIPANTS: Three hundred and eighty-four consenting women, aged 18-49 years, who had used hormonal contraceptives for at least 3 months prior to the study. STUDY OUTCOME Dyslipidaemias (defined as derangements in lipid profile levels which included total cholesterol ≥200 mg/dL, high-density lipoprotein <40 mg/dL, triglyceride >150 mg/dL or low-density lipoprotein ≥160 mg/dL) for which the prevalence and associated factors were obtained. RESULTS The prevalence of dyslipidaemias was 63.3% (95% CI: 58.4 to 68.1). Body mass index (BMI) (PR=1.33, 95% CI: 1.15 to 1.54, p<0.001) and use of antiretroviral therapy (ART) (PR=1.21, 95% CI: 1.03 to 1.42, p=0.020) were the factors significantly associated with dyslipidaemias. CONCLUSION Dyslipidaemias were present in more than half the participants, and this puts them at risk for cardiovascular diseases. The high-risk groups were women with a BMI greater than 25 Kg/m2 and those who were on ART. Therefore, lipid profiles should be assessed in women using hormonal contraceptives in order to manage them better.
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Affiliation(s)
- Ritah Bakesiima
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Pauline Byakika-Kibwika
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - James K Tumwine
- Department of Pediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joan N Kalyango
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Gloria Nabaasa
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Irene Najjingo
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Grace S Nabaggala
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Francis Olweny
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Charles Karamagi
- Department of Pediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
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Adeyanju OA, Soetan OA, Soladoye AO, Olatunji LA. Oral hormonal therapy with ethinylestradiol–levonorgestrel improves insulin resistance, obesity, and glycogen synthase kinase-3 independent of circulating mineralocorticoid in estrogen-deficient rats. Can J Physiol Pharmacol 2018; 96:577-586. [DOI: 10.1139/cjpp-2017-0630] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Estrogen deficiency has been associated with increased incidence of cardiovascular diseases , and recent clinical trials of standard formulations of hormonal therapies have not demonstrated consistent beneficial effects. Estrogen–progestin therapy has been used as exogenous estrogen to normalize depressed estrogen level during menopause. Ovariectomized rodents mimic an estrogen-deficient state in that they develop cardiometabolic dysfunction, including insulin resistance (IR). We therefore hypothesized that hormonal therapy with combined oral contraceptive steroids, ethinylestradiol–levonorgestrel (EEL), improves IR, obesity, and glycogen synthase kinase-3 (GSK-3) through reduction of circulating mineralocorticoid in ovariectomized rats. Twelve-week-old female Wistar rats were divided into 4 groups: sham-operated (SHM) and ovariectomized (OVX) rats were treated with or without EEL (1.0 μg ethinylestradiol and 5.0 μg levonorgestrel) daily for 8 weeks. Results showed that OVX or SHM + EEL treated rats had increased HOMA-IR (homeostatic model assessment of IR), 1 h postload glucose, HOMA-β, triglycerides (TG), total cholesterol (TC), TC/HDL cholesterol, TG/HDL cholesterol, plasma insulin, GSK-3, corticosterone, and aldosterone. On the other hand, OVX + EEL treatment ameliorated all these effects except that of aldosterone. Taken together, the results demonstrate that oral hormonal replacement with EEL improves IR and pancreatic β-cell function and suppresses GSK-3 and glucocorticoid independent of circulating aldosterone, suggesting a positive cardiometabolic effect of oral EEL therapy in estrogen-deficient rats.
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Affiliation(s)
- Oluwaseun A. Adeyanju
- Cardiovascular Research Laboratory, Department of Physiology, University of Ilorin, Ilorin, Nigeria
- Cardiometabolic Research Unit, Department of Physiology, Afe Babalola University, Ado-Ekiti, Ekiti State, Nigeria
| | - Olaniyi A. Soetan
- Cardiovascular Research Laboratory, Department of Physiology, University of Ilorin, Ilorin, Nigeria
| | - Ayodele O. Soladoye
- Cardiovascular Research Laboratory, Department of Physiology, University of Ilorin, Ilorin, Nigeria
| | - Lawrence A. Olatunji
- Cardiovascular Research Laboratory, Department of Physiology, University of Ilorin, Ilorin, Nigeria
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Liu H, Yao J, Wang W, Zhang D. Association between duration of oral contraceptive use and risk of hypertension: A meta-analysis. J Clin Hypertens (Greenwich) 2017; 19:1032-1041. [DOI: 10.1111/jch.13042] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 04/10/2017] [Accepted: 04/17/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Hui Liu
- Department of Epidemiology and Health Statistics; Qingdao University Medical College; Qingdao China
| | - Jie Yao
- Department of Epidemiology and Health Statistics; Qingdao University Medical College; Qingdao China
| | - Weijing Wang
- Department of Epidemiology and Health Statistics; Qingdao University Medical College; Qingdao China
| | - Dongfeng Zhang
- Department of Epidemiology and Health Statistics; Qingdao University Medical College; Qingdao China
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Olatunji LA, Usman TO, Seok YM, Kim IK. Activation of cardiac renin-angiotensin system and plasminogen activator inhibitor-1 gene expressions in oral contraceptive-induced cardiometabolic disorder. Arch Physiol Biochem 2017; 123:1-8. [PMID: 26934364 DOI: 10.3109/13813455.2016.1160935] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Clinical studies have shown that combined oral contraceptive (COC) use is associated with cardiometabolic disturbances. Elevated renin-angiotensin system (RAS) and plasminogen activator inhibitor-1 (PAI-1) have also been implicated in the development of cardiometabolic events. OBJECTIVE To determine the effect of COC treatment on cardiac RAS and PAI-1 gene expressions, and whether the effect is circulating aldosterone or corticosterone dependent. METHODS Female rats were treated (p.o.) with olive oil (vehicle) or COC (1.0 µg ethinylestradiol and 10.0 µg norgestrel) daily for six weeks. RESULTS COC treatment led to increases in blood pressure, HOMA-IR, Ace1 mRNA, Atr1 mRNA, Pai1 mRNA, cardiac PAI-1, plasma PAI-1, C-reactive protein, uric acid, insulin and corticosterone. COC treatment also led to dyslipidemia, decreased glucose tolerance and plasma 17β-estradiol. CONCLUSION These results demonstrates that hypertension and insulin resistance induced by COC is associated with increased cardiac RAS and PAI-1 gene expression, which is likely to be through corticosterone-dependent but not aldosterone-dependent mechanism.
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Affiliation(s)
- Lawrence A Olatunji
- a Department of Physiology , Cardiovascular and Molecular Physiology Unit, College of Health Sciences University of Ilorin , P.M.B. 1515 , Ilorin , Nigeria
- b Cardiovascular Research Institute, Kyungpook National University School of Medicine , Daegu , Republic of Korea
| | - Taofeek O Usman
- a Department of Physiology , Cardiovascular and Molecular Physiology Unit, College of Health Sciences University of Ilorin , P.M.B. 1515 , Ilorin , Nigeria
| | - Young-Mi Seok
- b Cardiovascular Research Institute, Kyungpook National University School of Medicine , Daegu , Republic of Korea
- c Korea Promotion Institute for Traditional Medicine Industry , Gyeongsan , Gyeongbuk , Republic of Korea , and
| | - In-Kyeom Kim
- b Cardiovascular Research Institute, Kyungpook National University School of Medicine , Daegu , Republic of Korea
- d Department of Pharmacology , Kyungpook National University School of Medicine , Daegu , Republic of Korea
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Olatunji LA, Seok YM, Igunnu A, Kang SH, Kim IK. Combined oral contraceptive-induced hypertension is accompanied by endothelial dysfunction and upregulated intrarenal angiotensin II type 1 receptor gene expression. Naunyn Schmiedebergs Arch Pharmacol 2016; 389:1147-1157. [PMID: 27447455 DOI: 10.1007/s00210-016-1272-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 07/03/2016] [Indexed: 01/09/2023]
Abstract
Combined oral contraceptive (COC) use is associated with increased risk of developing hypertension. Activation of the intrarenal renin-angiotensin system (RAS) and endothelial dysfunction play an important role in the development of hypertension. We tested the hypothesis that COC causes hypertension that is associated with endothelial dysfunction and upregulation of intrarenal angiotensin-converting enzyme 1 (Ace1) and angiotensin II type 1 receptor (At1r). Female Sprague-Dawley rats aged 12 weeks received (p.o.) olive oil (control) and a combination of 0.1 μg ethinylestradiol and 1.0 μg norgestrel (low COC) or 1.0 μg ethinylestradiol and 10.0 μg norgestrel (high COC) daily for 6 weeks. Blood pressure was recorded by tail cuff plethysmography. Expression of genes in kidney cortex was determined by quantitative real-time polymerase chain reaction. COC treatment led to increased blood pressure, circulating uric acid, C-reactive protein and plasminogen activator inhibitor-1, renal uric acid, and expression of renal Ace1 and At1r. COC treatment resulted in increased contractile responses to phenylephrine in endothelium-denuded aortic rings. Endothelium-dependent relaxation responses to acetylcholine, but not endothelium-independent relaxation responses to nitric oxide (NO) donation by sodium nitroprusside, were attenuated in COC-exposed rings. Impaired relaxation responses to acetylcholine were masked by the presence of NO synthase inhibitor (L-NAME) in the COC-exposed rings, whereas the responses to acetylcholine in the presence of selective cyclooxygenase-2 inhibitor (NS-398) were enhanced. These findings indicate that COC induces hypertension that is accompanied by endothelial dysfunction, upregulated intrarenal Ace1 and At1r expression, and elevated proinflammatory biomarkers.
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Affiliation(s)
- Lawrence A Olatunji
- Department of Physiology, University of Ilorin, Ilorin, Nigeria.,Cardiovascular Research Institute, Kyungpook National University School of Medicine, 680 GukchaeBosang Street, Daegu, 41944, Republic of Korea
| | - Young-Mi Seok
- Cardiovascular Research Institute, Kyungpook National University School of Medicine, 680 GukchaeBosang Street, Daegu, 41944, Republic of Korea.,National Development Institute of Korean Medicine, Hwarang-ro 94(Gapje-dong), Gyeongsan, Gyeongbuk, 38540, Republic of Korea
| | - Adedoyin Igunnu
- Cardiovascular Research Institute, Kyungpook National University School of Medicine, 680 GukchaeBosang Street, Daegu, 41944, Republic of Korea
| | - Seol-Hee Kang
- Cardiovascular Research Institute, Kyungpook National University School of Medicine, 680 GukchaeBosang Street, Daegu, 41944, Republic of Korea.,Department of Pharmacology, Kyungpook National University School of Medicine, 680 GukchaeBosang Street, Daegu, 41944, Republic of Korea.,Cell and Matrix Research Institute, Kyungpook National University School of Medicine, 680 GukchaeBosang Street, Daegu, 41944, Republic of Korea.,BK21 Plus KNU Biomedical Convergence Program, Department of Biomedical Science, Kyungpook National University School of Medicine, 680 GukchaeBosang Street, Daegu, 41944, Republic of Korea
| | - In-Kyeom Kim
- Cardiovascular Research Institute, Kyungpook National University School of Medicine, 680 GukchaeBosang Street, Daegu, 41944, Republic of Korea. .,Department of Pharmacology, Kyungpook National University School of Medicine, 680 GukchaeBosang Street, Daegu, 41944, Republic of Korea. .,Cell and Matrix Research Institute, Kyungpook National University School of Medicine, 680 GukchaeBosang Street, Daegu, 41944, Republic of Korea. .,BK21 Plus KNU Biomedical Convergence Program, Department of Biomedical Science, Kyungpook National University School of Medicine, 680 GukchaeBosang Street, Daegu, 41944, Republic of Korea.
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Olatunji LA, Omolekulo TE, Usman TO, Kim I. Improvement of oral contraceptive-induced glucose dysregulation and dyslipidemia by valproic acid is independent of circulating corticosterone. Arch Physiol Biochem 2016; 122:123-9. [PMID: 26855320 DOI: 10.3109/13813455.2016.1151892] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Cardiometabolic disorders are rapidly becoming major public health challenges. Valproic acid (VPA) is a widely prescribed anticonvulsant drug. OBJECTIVE We hypothesized that treatment with VPA would improve the regulation of glucose and atherogenic dyslipidemia through reduction in circulating corticosterone. METHODS Female Wistar rats recieved (p.o.) combined oral contraceptive (COC) containing 1.0 µg ethinylestradiol plus 5.0 µg levonorgestrel and valproic acid (VPA; 20 mg) for 8 weeks. RESULTS Treatment with COC led to elevated fasting blood glucose, insulin, corticosterone, triglycerides (TG), TG/HDL-cholesterol ratio, insulin resistance (IR) and impaired glucose tolerance. VPA significantly attenuated the alterations induced by COC treatment, but did not affect the corticosterone level. However, VPA treatment led to significant increases in plasma insulin, corticosterone, atherogenic lipids and impaired glucose tolerance in rats not treated with COC. CONCLUSION The findings in this study suggest that VPA mitigates against the development of COC-induced insulin resistance and dyslipidemia independent of elevated circulating corticosterone.
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Affiliation(s)
- Lawrence A Olatunji
- a Cardiovascular and Molecular Physiology Unit, Department of Physiology, College of Health Sciences University of Ilorin , Ilorin , Nigeria
- b Cardiovascular Research Institute, Kyungpook National University School of Medicine , Daegu , Republic of Korea , and
| | - Tolulope E Omolekulo
- a Cardiovascular and Molecular Physiology Unit, Department of Physiology, College of Health Sciences University of Ilorin , Ilorin , Nigeria
| | - Taofeek O Usman
- a Cardiovascular and Molecular Physiology Unit, Department of Physiology, College of Health Sciences University of Ilorin , Ilorin , Nigeria
| | - InKyeom Kim
- b Cardiovascular Research Institute, Kyungpook National University School of Medicine , Daegu , Republic of Korea , and
- c Department of Pharmacology , Kyungpook National University School of Medicine , Daegu , Republic of Korea
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Park H, Kim K. Associations between oral contraceptive use and risks of hypertension and prehypertension in a cross-sectional study of Korean women. BMC Womens Health 2013; 13:39. [PMID: 24144402 PMCID: PMC3853233 DOI: 10.1186/1472-6874-13-39] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 10/17/2013] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The effect of commonly used oral contraceptives (OCs) on blood pressure is still unclear. The aim of this study was to examine the relationship between OCs use and blood pressure and the prevalence of hypertension in a population-based sample of Korean women. METHODS A cross-sectional study was conducted using data from 3356 participants aged 35-55 years collected in the 2007-2009 Korea National Health and Nutrition Examination Surveys. OC use and demographic characteristics were obtained from participants using a questionnaire, and blood pressure was measured with a mercury sphygmomanometer. RESULTS Longer duration of OC use was positively associated with increasing levels of systolic blood pressure and diastolic blood pressure (p for trend <0.001). After adjusting for covariates, the odds ratio (OR) of hypertension was significantly increased in longer-term (>24 months) OC users (OR 1.96; 95% confidence interval (CI) 1.03-3.73) compared with those who had never used OCs. Additionally, use of OCs >24 months was associated with increased odds of prehypertension (adjusted OR 2.23; 95% CI 1.28-3.90) and hypertension or prehypertension (adjusted OR 2.13; 95% CI 1.37-3.32). CONCLUSION This study found a statistically significant association between OC use and blood pressure or hypertension among Korean women.
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Affiliation(s)
- Hyejin Park
- Department of International Medical Management, Catholic University of Daegu, Kyungbuk 712-702, Republic of Korea
| | - Kisok Kim
- Department of Pharmacy, Keimyung University, Daegu 704-701, Republic of Korea
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General and central obesity, combined oral contraceptive use and hypertension in Chinese women. Am J Hypertens 2011; 24:1324-30. [PMID: 21881619 DOI: 10.1038/ajh.2011.157] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Asians have different body fat distributions and disease characteristics compared with Caucasians. The purpose of this study was to evaluate general and central obesity, combined oral contraceptive (COC) use, and their joint effects on the risk of hypertension in Chinese women. METHODS A case-control study including 1,760 women (878 hypertensive cases and 882 normotensive controls) was conducted in China. Body weight, height, waist circumference (WC), blood pressure, serum lipids, and apolipoproteins were measured. History of contraceptive use and relevant factors were investigated. Odds ratio (OR) with 95% confidence interval (CI) was estimated for hypertension-related factors under unconditional logistic regression model. RESULTS Our study showed that increased body mass index (BMI), increased WC, and COC use were risk factors for hypertension with an OR (95% CI) of 2.19 (1.69-2.83), 1.46 (1.13-1.88), and 1.26 (1.02-1.56), respectively. Compared with WC, BMI was more strongly associated with hypertension risk (OR 3.40, 95% CI 2.28-5.05, for highest vs. lowest quartile) and was a better predictor for blood pressure. COC users had a 1.39-fold (OR 1.39, 95% CI 1.14-1.69) increased risk compared with the nonusers, while stopping COC was associated with a 36% reduced risk (OR 0.64, 95% CI 0.42-0.98). The risk increased dramatically in combination of COC use with a BMI ≥28 kg/m(2) or WC ≥90 cm (OR 8.02, 95% CI 5.05-12.74; OR 5.76, 95% CI 3.65-9.12, respectively). CONCLUSIONS General and central obesity, COC use, and their joint effects significantly increased the risk of hypertension in Chinese women.
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