Smoking, oral contraceptives, and cardiovascular reactivity to stress

Objective: To investigate the effects of smoking and oral contraceptive (OC ) formulation on hemodynamic responses to stress in women. Methods: Twenty-three smokers and 23 nonsmokers taking different OC formula tions tie, containing higher or lower androgenic progesterones) were tested for cardiovascular reactivity during mathematic, speech preparation, speec h, and cold presser stress. Results: During mental stress, smokers, regardless of OC formulation, had l ower systolic blood pressure (BP) (eg, 10.2 versus 15.1 mmHg, P <.05), hear t rate leg, 7.5 versus 15.0 beats per minute, P <.01), and cardiac index re activity leg, 0.08 versus 0.48 L/minute/M-2, P <.01) but greater vascular r esistance index responses leg, 115.6 versus -51.9 dyne-sec cm(-5) . M-2, P <.05). Women who took higher androgen OCs, regardless of smoking status, sh owed greater vascular resistance index increases during speech stress than those who took lower androgen OCs (215.8 versus 9.4 dyne-sec . cm(-5) . M-2 , P <.05). Smokers who took more androgenic OCs had greater systolic BP res ponses to speech preparation compared with nonsmokers who took the same OCs (12.1 venus 8.1 mmHg, P <.05), and smokers who took lower androgen OCs (12 .1 versus 4.4 mmHg, P <.05). Least-squares means examination found that smo kers who took higher androgen OCs had greater vascular resistance index inc reases to all mental stressors than nonsmokers who took lower androgen OCs. Conclusion: Higher androgen OCs might be linked to greater vascular and BP increases during stress, especially in smokers. Given that increased vascul ar resistance and BP contribute to cardiovascular mortality, those results suggest that androgenic profiles of synthetic progesterones might be an imp ortant consideration in OC choice. (Obstet Gynecol 2000;95:78-83. (C) 2000 by The American College of Obstetricians and Gynecologists.).