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Kardiovaskuläres Risiko hormoneller Kontrazeptiva – ein Update

Cardiovascular risk of hormonal contraceptives – an update

  • Leitthema
  • Published:
Der Gynäkologe Aims and scope

Zusammenfassung

Hintergrund

Seit den frühen 1960er-Jahren ist bekannt, dass die Anwendung hormoneller Kontrazeptiva mit einem erhöhten kardiovaskulären Risiko verbunden ist. Studienergebnisse aus den letzten 8 Jahren haben zu Diskussionen über die Nutzen-Risiko-Bewertung einzelner Präparate geführt.

Fragestellung

Übersicht über die Inzidenz kardiovaskulärer Ereignisse bei Nutzern und Nichtnutzern hormoneller Kontrazeptiva, Differenzierung der Risiken nach Produktgruppen und anschließende Nutzen-Risiko-Bewertung.

Material und Methode

Zusammenfassende Auswertung von eigenen und anderen Studien, Analyse und Diskussion methodologischer Schwächen der relevanten Studien, Empfehlungen auf der Basis der Ergebnisse.

Ergebnisse

Studienergebnisse der letzten Jahre führen zu keiner grundsätzlich neuen Nutzen-Risiko-Bewertung hormoneller Kontrazeptiva. Allerdings gibt es neue Erkenntnisse zum zeitlichen Verlauf des kardiovaskulären Risikos, zu Risiken bei wiederholtem Starten und Absetzen hormoneller Kontrazeptiva und zur überadditiven Risikosteigerung bei gleichzeitigem Vorliegen mehrerer kardiovaskulärer Risikofaktoren.

Schlussfolgerungen

Das Nutzen-Risiko-Verhältnis hormoneller Kontrazeptiva – einschließlich kombinierter oraler Kontrazeptiva – ist bei jungen Frauen ohne kardiovaskuläre Risikofaktoren, die eine zuverlässige und reversible Verhütungsmethode wünschen, fast immer positiv. Bei Vorliegen mehrerer kardiovaskulärer Risikofaktoren sollten nur östrogenfreie hormonelle Kontrazeptiva oder nichthormonelle Methoden zum Einsatz kommen. Wiederholtes Absetzen und kurzfristige Wiedereinnahmen kombinierter hormoneller Kontrazeptiva sollten vermieden werden.

Abstract

Background

Since the early 1960s, it has been known that hormonal contraceptives are associated with an increased cardiovascular risk. New study results from the last 8 years have triggered discussions on the benefit–risk ratio of individual products.

Objectives

The incidence rates of cardiovascular events in users and nonusers of hormonal contraceptives are summarized, risks associated with individual product groups are identified, and the benefit–risk ratio of these groups are assessed.

Materials and methods

Evaluation of the author’s studies and external studies are summarized; methodological shortcomings of relevant studies are analyzed and discussed; recommendations given based on the results.

Results

Recent study results do not lead to a fundamentally new assessment of the risk–benefit ratio of hormonal contraceptives. Nevertheless, there are new insights into the time course of cardiovascular risk, the risk of repeated starting and stopping of hormonal contraceptives, and the overadditive increase in risk associated with the presence of multiple cardiovascular risk factors.

Conclusions

The risk-benefit ratio of hormonal contraceptives – including combined oral contraceptives – is almost always positive in young women without cardiovascular risk factors who need reversible and reliable contraception. In the presence of multiple cardiovascular risk factors, only estrogen-free hormonal contraceptives or hormone-free methods should be used. Repeated stopping and short-term restart of combined hormonal contraceptives should be avoided.

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Authors and Affiliations

  1. Pharmacoepidemiology Berlin, ZEG – Berlin Center for Epidemiology and Health Research, Invalidenstraße 115, 10115, Berlin, Deutschland

    J. Dinger

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Interessenkonflikt

J. Dinger weist auf folgende Beziehungen hin: J. Dinger war Studienleiter zahlreicher epidemiologischer Studien, die von den zuständigen Ethikkommissionen genehmigt wurden; darunter Studien, die von Herstellern hormoneller Kontrazeptiva finanziert und von unabhängigen Gremien überwacht wurden. Dieser Beitrag beinhaltet unter anderem einige dieser Studien.

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Dinger, J. Kardiovaskuläres Risiko hormoneller Kontrazeptiva – ein Update. Gynäkologe 48, 643–650 (2015). https://doi.org/10.1007/s00129-015-3739-3

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