Cardiovascular risk biomarkers among oral and vaginal hormonal contraceptive users.

Abstract

Combined hormonal contraceptives (CHCs) possess an inherent risk of thrombus related events such as stroke, coronary heart disease, venous thrombosis and pulmonary embolism. Recently, NuvaRing, a vaginal CHC, has been introduced to the market. The purpose of this study is to elucidate alterations in cardiovascular risk biomarkers among young women using combined oral contraceptives (COCs) or the NuvaRing compared to a non-CHC using control group. We observed that NuvaRing users were older (p<0.0001) and had a greater incidence of family history of cardiovascular disease (CVD)/stroke (p=0.034) when compared to the control. COC users reported having a more regular sleeping habit (p=0.010). The COC and NuvaRing groups had more white participants and they consumed alcohol more often. No significant alterations were observed in complete blood cell count with differentials, plasminogen activator inhibitor-1, thrombin/antithrombin-III, D-dimer, fibrinogen or von Willebrand factor. After adjusting for age, race, alcohol consumption, sleeping habit and family history of CVD/stroke, when compared to control subjects we observed COC and NuvaRing users had elevated levels of C-reactive protein and Factor VII while having lower soluble E-selectin, soluble thrombomodulin, and Tissue Factor Pathway Inhibitor concentration. COC users had a significantly elevated soluble CD40 ligand level when compared to both control (p<0.0001) and NuvaRing (p<0.0001) but the NuvaRing CD40 ligand level was essentially identical to the control (p=0.5996). When compared to the control group, COC users had reduced levels of soluble P-selectin (p=0.0029) while NuvaRing users also had reduced levels but failed to reach significance (p=0.011). These results indicate significant alterations in several inflammatory and procoagulant blood biomarkers among CHC users. Larger, long-term longitudinal studies are required to further assess the effect of these biomarker alterations on vascular events.