Cardiovascular Health and Contraceptive Use

The findings underscore the importance of discussing CV health in the early reproductive years of women.

Italy: A recent review in ESC Heart Failure has suggested that in women of reproductive age taking combined oral contraceptives (COCs), the presence of obesity or being overweight may increase cardiovascular (CV) risk, mainly the venous thromboembolism (VTE) risk.

It is well-known that estrogen-containing contraceptive products and obesity are independent cardiovascular risk factors. Still, many obese women continue to receive hormonal products prescription that contains estrogens for their contraception.

In cardiovascular patients, obesity is a significant challenge. The use of contraceptives is another well-known CV risk factor and is associated with increased thrombotic risk. Both these conditions as such are conceived as potentially reversible risk factors. There has been increased recognition of their effects on cardiovascular outcomes.

In simpler words, obesity and estrogen-containing contraceptive products are well-known independent cardiovascular risk factors. However, a significant number of obese women continue to receive prescriptions for hormonal products that contain estrogen for their contraception. Considering this, Giuseppe M.C. Rosano, Centre for Clinical and Basic Research, Department of Medical Sciences, IRCCS San Raffaele Pisana, Rome, Italy, and colleagues conducted a narrative review that discussed the ongoing research, the latest evidence, and controversial issues on the synergistic effect of contraceptive use and obesity, about cardiovascular risk.

Critical Points of the Review

• There is compelling evidence of an interplay between obesity and contraception in increasing cardiovascular risk.
• Women who present both uses of combined oral contraceptives (COCs) and obesity have a higher risk (between 12 and 24 times) of developing venous thromboembolism than non-obese non-COC users.
• Data offer new insights to raise awareness of clinicians on the cardiovascular risk in the clinical management of obese women.
• The synergistic effect of obesity and COCs on deep venous thrombosis risk must be considered when prescribing hormonal contraception.
• Progestin-only products are a safer alternative to COCs in overweight or obese patients.
• Obese women taking contraceptives should be viewed as an 'at risk' population. As such, they should receive advice to change their lifestyle and avoid other cardiovascular risk factors as a form of primary prevention. This indication should be extended to young women, as data show that COCs should be avoided in obese women of any age.

The findings imply that progestin-only products (POPs) should be considered a safer alternative compared to combined oral contraceptives in obese women and women connecting several risks of thromboembolism seeking hormonal contraception.

The researchers wrote, "Combined oral contraceptives increase the risk of arterial thromboembolism (ATE) and venous thromboembolism versus non-use."

"The procoagulant state induced by oxidative stress, COCs, and a pro-inflammatory state provides the COCs-mediated predisposition to ATE and VTE. POPs do not raise risks of ATE and VTE, with some remaining doubts with injectable depot medroxyprogesterone (DMPA)," they conclude.

Reference

Rosano GMC, Rodriguez-Martinez MA, Spoletini I, Regidor PA. Obesity and contraceptive use: impact on cardiovascular risk. ESC Heart Fail. 2022 Sep 14. doi: 10.1002/ehf2.14104. Epub ahead of print. PMID: 36103980.