How Contraceptive Use And Obesity Can Affect Cardiovascular Risk

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The use of safe and effective contraception is crucial for preventing unwanted pregnancy in women of all body sizes. However, choosing the appropriate birth control method is not as easy as it seems despite the comprehensive option of contraceptive methods available to women. Since these contraceptives often come with various side effects that can primarily affect a woman’s health or capacity to perform her usual routines. 

For example, when counseling women with obesity about contraception, it is essential to consider how obesity may affect the safety and efficacy of various contraceptive methods. Specific birth control methods can have severe disadvantages, including an increased risk of heart attack, stroke, and blood clots which are also found to be common conditions linked to obesity or being overweight. 

In a recent review paper published in ESC Heart Failure, a journal of the European Society of Cardiology (ESC), the researchers examined the independent effects of obesity and contraceptives and their complementary effects on risks of Venous thromboembolism (VTE), a term referring to blood clots in the veins. This article will highlight some of the evidence discovered by the researchers on how birth control methods and obesity can impact cardiovascular risk.

The Synergistic Impact of Contraceptive Use And Obesity On Cardiovascular risk

One of the most prevalent cardiovascular illnesses is venous thromboembolism (VTE), also known as myocardial infarction (MI) and stroke. It pertains to the blood clot development in the vein and is thought to occur between 1 and 2 times every 1000 person-years.

Obesity and the use of contraceptives, specifically estrogen-containing contraceptives, are two factors that are well-known to be associated with the chances of VTE. However, despite several pieces of evidence supporting its association, obese women continue to receive these drugs.

According to the World Health Organization, 15% of adult women globally are obese, making up more than 1 billion people worldwide. Body mass index (BMI) causes a gradual increase in VTE risk, which is more than double in obese women compared to non-obese women. Women under 40 who develop VTE are most significantly affected by obesity; their risk is five times higher than non-obese women.

It is crucial to consider the elevated risk of VTE in younger obese women aged 40 or younger because this demographic frequently uses contraception, a risk factor for VTE and PE in and of itself.

Users of combined oral contraceptives had a three- to seven-fold increased risk of VTE compared to non-users, raising the risk of VTE in young women. Contrarily, there is no increased risk of VTE associated with progestin-only products.

Compared to non-obese, non-COC users, obese women who also take COCs have cardiovascular risks between 12 and 24 times higher, primarily VTE risks.

It is vital to evaluate the consolidated thrombotic risk brought on by each VTE risk, if present, in the same subject because VTE risks frequently occur in the same subject because obesity and overweight can be linked to smoking, arterial hypertension, and age.

Therefore, the researchers recommended POPs to be evaluated as a safer option for COCs in patients with overweight or obesity instead of COCs due to the synergistic effect of obesity and COCs on DVT risk.

Journal Reference

Rosano, G. M. C., Rodriguez‐Martinez, M. A., Spoletini, I., & Regidor, P. A. (2022). Obesity and contraceptive use: Impact on Cardiovascular Risk. ESC Heart Failure. https://doi.org/10.1002/ehf2.14104 

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