Some contraceptives may increase the risk of thrombotic events in obese women

September 15, 2022

2 minutes to read

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Researchers report that the use of combined oral contraceptives in obese women may lead to a higher CV risk in the form of venous and arterial thromboembolism.

In a review published in ESC . heart failurethe researchers stated that special consideration may be needed when evaluating CV risk in obese women who weigh with their doctor the safest contraceptive option.

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“Obesity… a major challenge for cardiovascular patients. Indeed, obesity exacerbates cardiac dysfunction along with cardiac hypertrophy, exacerbates cardiac insulin resistance, and lowers rates of basal and insulin-stimulated glucose oxidation,” Giuseppe MC RossanoAnd the Masters, PhD, Consultant Cardiologist and Professor of Cardiology, Center for Clinical and Basic Research, Department of Medical Sciences at IRCCS San Raffaele Pisana in Rome, and colleagues wrote. “Contraceptive use is another known risk factor for cardiovascular disease, as it is associated with an increased risk of stroke.

“As such, these two conditions are seen as reversible risk factors,” the researchers wrote. “Their effects on cardiovascular outcomes are increasingly being recognized.”

Rosano et al. conducted a narrative review to assess the combined effect of obesity and contraceptive use on the risk of venous and arterial thromboembolism.

Use of combined oral contraceptives causes a thrombophilic state, altering oxidative balance and modulating low-grade inflammatory status in women who use them, which may increase the risk of venous thromboembolism, according to the review.

Thus, CV risk, which is primarily the risk of venous thromboembolism, is 12 to 24 times greater in obese women using combined oral contraceptives than in non-obese women not using combined oral contraceptives, according to the review.

Researchers cited evidence published in International Journal of Obesity and Related Metabolic Disorders that have shown that progestin-only contraceptive products may not increase the risk of venous thromboembolism and arterial thromboembolic events; However, doubts remain regarding a progestin-only depot containing injectable progestins, according to the review.

Therefore, Rosano and colleagues recommended obesity and lifestyle considerations when prescribing hormonal contraceptives because of these increased risks associated with combined oral contraceptives, and that progestin-only products may be a safer alternative for obese women.

“Because VTE risk tends to correlate in the same subject and that overweight/obesity can be associated with cigarette smoking, arterial hypertension, and age, it is critical to assess the standardized thrombosis risk of having all VTE risk if present in the same subject,” the researchers wrote. . “The recommendation is to exercise caution when using COCs in overweight and obese patients, and to choose safer alternatives when prescribing hormonal contraceptives due to the increasing global prevalence of obesity.”

See the document for full details of the data review and the researchers’ recommendations.