Riesgo cardiovascular en mujeres que utilizan drospirenona/estetrol vs levonorgestrel/etinilestradiol: revisión sistemática

Abstract

Background: Combined hormonal contraceptives have been associated with cardiovascular events such as venous thromboembolism, hypertension, myocardial infarction, and stroke. Differences in the hormonal composition between drospirenone/estetrol (E4/DRSP) and levonorgestrel/ethinyl estradiol (EE/LNG) may influence the cardiovascular safety profile of users. Objective: To assess cardiovascular risk in women using E4/DRSP compared with EE/LNG through a systematic review of clinical studies. Methods: A systematic review was conducted in PubMed, ScienceDirect, and SciELO, including randomized clinical trials and observational studies published in English and Spanish. Methodological quality was assessed using the Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale. Secondary studies, those with insufficient data, or those involving irrelevant populations were excluded. The findings were synthesized through a narrative analysis. Results: Twenty-three studies were included. E4/DRSP showed a lower cardiovascular impact compared with EE/LNG, with an average incidence of venous thromboembolism of 3.66 cases per 10,000 woman-years versus 6–8 cases for EE/LNG. In addition, E4/DRSP was associated with a safer profile in women with preexisting risk factors, such as obesity and hypertension, and had a lower impact on hemostatic and metabolic parameters. Keywords: cardiovascular risk, drospirenone/estetrol, levonorgestrel/ethinyl estradiol, hormonal contraceptives, venous thromboembolism