Hormonal Contraceptives, Stress, and Cardiovascular Risk: New Insights Emerge

A groundbreaking study has delved into the complex relationship between hormonal contraceptive use, stress-related disorders, and the associated cardiovascular and thrombotic risks in women. With over 400,000 women in the United States dying annually from cardiovascular disease (CVD)—and stress identified as a major risk factor—this research addresses a critical public health concern. Stress-related psychiatric disorders, such as anxiety and post-traumatic stress disorder (PTSD), are notably more prevalent in women.

Previous research on hormonal contraceptives, utilized by approximately 9.1 million women in the U.S., has largely focused on young, healthy individuals. This left a significant gap in understanding their effects on women with stress-related psychiatric disorders. This study uniquely addresses this knowledge gap, being the first to examine the combined effects of these factors on cardiovascular and thrombosis risk.

Research Questions

Led by Jordan Thomas, PhD, from the University of Kansas, the study specifically explored whether hormonal contraceptive use correlates with cardiovascular and thrombotic risk in women both with and without stress-related disorders. A key question was whether women with a history of depression, anxiety, or PTSD who use hormonal contraceptives exhibit a higher risk of major adverse cardiovascular events (MACE) or deep-vein thrombosis compared to those without such mental health histories.

Methodology

Researchers conducted an analysis of healthcare records from 31,824 women who participated in the Mass General Brigham Biobank. The methodological approach involved identifying specific medical codes for diagnoses of stress-related disorders, MACE, deep-vein thrombosis, and prescriptions for hormonal contraceptives.

Key Findings

The study's preliminary findings reveal important distinctions in cardiovascular risk:

• For the majority of women, including those with a history of anxiety or depression, hormonal contraceptive use was associated with a lower risk of MACE.
• Crucially, this protective association was not observed in women diagnosed with PTSD.

These results suggest that cardiovascular risk may vary among women using hormonal contraceptives, particularly differing for those with PTSD.

Should these findings be corroborated by future research, they underscore a potential need for clinicians to integrate stress-related psychiatric disorders into discussions regarding hormonal contraceptive options with patients.

Future Research

Plans for follow-up studies include a clinical investigation aimed at collecting new data on how specific hormonal contraceptive formulas relate to CVD risk factors. These factors encompass blood pressure, vascular endothelial function, and various blood-based clotting markers. Researchers also intend to test whether these effects differ between women with and without stress-related psychiatric disorders. Participants in these subsequent studies would undergo yearly follow-up visits to monitor clinical outcomes, such as thrombotic events.