07.06 Long Term Oral Contraceptive use is an Independent Risk Factor for Arterial Stiffening

Abstract

Background

Oral contraceptives (OC) are among the most frequently used drugs in the world. We describe the population effects of current and longterm OC exposure on carotid-femoral pulse wave velocity (PWV).

Methods

The Asklepios study is a representative sample (n = 2524, aged 35–55 years, 1301 women) from the Belgian general population, free from overt cardiovascular disease. The subjects were extensively screened; carotid-femoral PWV was measured using Doppler echography.

Results

Of 1301 women (median age 45.7 years), 27.4% were actively taking OC. However, past use of OC is far more prevalent with 81% having taken OC (median exposure 13 years).

Age-adjusted PWV was higher in women currently taking OC: 6.75 versus 6.55 m/s (difference 0.19±0.09 m/s; p = 0.034). However, current OC users also had higher blood pressures (BP): systolic +4.4±0.9 mmHg, p<0.001; diastolic +2.3±0.6 mmHg, p<0.001. After adjustment for BP, the difference in PWV between current OC users and non-users became non-significant: 6.60 versus 6.62 m/s (difference 0.02±0.09 m/s; p = 0.814). Duration of OC use, in contrast, remained a significant determinant of PWV, even after adjustment for age, BP, lipids, body size, heart rate, drug therapy (lipid-lowering, antihypertensive), glycemic status and smoking: F = 6.1; p = 0.013. Per 10 years of OC exposure PWV increased by 0.10 m/s (0.02–0.18; p = 0.013).

Interpretation: Use of OC is associated with increased vascular stiffness. Current use is associated with increased PWV because OC’s increase BP, long-term use (probably through structural remodelling of the vessels) is an independent determinant of PWV, increasing PWV by 0.1 m/s per 10 years of exposure.