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Helping Your Patients Decide: Making Informed Health Choices About Hormonal Contraception

(Published June 2006)

Understanding Risk: Hormonal Contraceptives and Cardiovascular Adverse Events

Cardiovascular events, including VTE, stroke, and myocardial infarction (MI), although rare in absolute terms, are the most common major adverse events associated with combined hormonal contraceptives.1 However, the relative risk of these events varies substantially, depending on patient characteristics. Figure 10 presents the incidence of these events for women 30 to 34 years old. The risk is substantially higher for women who smoke and use OCs than for other women.1 Nonsmokers who use OCs have higher rates of nonfatal VTE than smokers who do not use OCs, but the latter population has higher rates of stroke and heart attack. Figure 10 also presents data on cardiovascular mortality, which varies similarly depending on patient characteristics. Again, the risk is substantially higher for OC users who smoke than for other women.

Given that the use of combined hormonal contraceptives is associated with an increased incidence of cardiovascular events and greater cardiovascular mortality, it’s important to put these data into context.

The incidence, or absolute risk, of cardiovascular events is low in women of reproductive age, with or without the use of combined hormonal contraceptives. In fact, smoking has a larger effect on the incidence and mortality of heart attack and stroke than does OC use at all ages.1 Because of the low absolute risk of cardiovascular adverse events, the noncontraceptive benefits of combined hormonal contraceptives outweigh these risks for most women.2

However, providers must consider risk factors such as smoking, hypertension, obesity, and diabetes when evaluating the risks associated with combined hormonal  contraceptives.2 Figure 11 demonstrates the importance of screening for cardiovascular risk factors. It shows the cardiovascular mortality rate for OC users who smoke based on whether their blood pressure was checked before OC use.1 Thus, simple screening for hypertension and prescribing OCs to women with normal (including medically controlled) blood pressures can lower the mortality risk associated with combined hormonal contraceptives.

References

  1. Farley TM, Collins J, Schlesselman JJ. Hormonal contraception and risk of cardiovascular disease: An international perspective. Contraception. 1998;57:211-30.
  2. Burkman R, Schlesselman JJ, Zieman M. Safety concerns and health benefits associated with oral contraception. Am J Obstet Gynecol. 2004;190(4 suppl):S5-S22.