Certain contraceptives may increase risk for thrombotic events in women with obesity
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Use of combined oral contraceptives in women with obesity may confer elevated CV risk in the form of venous and arterial thromboembolism, researchers reported.
In a review published in ESC Heart Failure, researchers stated that special consideration may be needed when assessing CV risk in women with obesity who, with their physician, are weighing the safest option for contraception.
“Obesity is ... a major challenge in cardiovascular patients. Indeed, adiposity exacerbates cardiac dysfunction along with hypertrophy, worsens cardiac insulin resistance, and reduces basal and insulin-stimulated glucose oxidation rates,” Giuseppe M.C. Rosano, MD, PhD, consultant cardiologist and professor of cardiology, Centre for Clinical and Basic Research, department of medical sciences at IRCCS San Raffaele Pisana in Rome, and colleagues wrote. “Contraceptive use is another well-known cardiovascular risk factor, being associated with increased thrombotic risk.
“As such, both these conditions are conceived as potentially reversible risk factors,” the researchers wrote. “Their effects on cardiovascular outcomes are increasingly recognized.”
Rosano and colleagues conducted a narrative review to assess the combined effect of obesity and contraceptive use on risk for venous and arterial thromboembolic events.
Combined oral contraceptive use induces a procoagulant state, alters oxidative homeostasis and modifies the low-grade inflammatory state in women who use them, which may increase risk for VTE, according to the review.
Consequently, CV risk, primarily risk for VTE, is 12 to 24 times greater in women with obesity who use combined oral contraceptives compared with women without obesity who do not use combined oral contraceptives, according to the review.
The researchers cited evidence published in the International Journal of Obesity and Related Metabolic Disorders that showed progestin-only contraceptive products may not increase risks for VTE and arterial thromboembolic events; however, doubts remain regarding injectable progestin-only depot medroxyprogesterone, according to the review.
Therefore, Rosano and colleagues recommended that obesity and lifestyle be considered when prescribing hormonal contraception due to this excess risk associated with combined oral contraception, and that progestin-only products may be a safer alternative in women with obesity.
“Given that VTE risks tend to associate in the same subject and that overweight/obesity can be associated with cigarette smoking, arterial hypertension and age, it is crucial to assess the consolidated thrombotic risk resulting from the presence of each VTE risk if present in the same subject,” the researchers wrote. “The recommendation is to exercise caution with the use of combined oral contraceptives in patients with overweight and obesity, choosing the safest alternatives when prescribing hormonal contraception due to the rising global prevalence of obesity.”
See the document for full details of the data review and the researchers’ recommendations.
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