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Cited by 75Venous Thromboembolism Diagnosis and ManagementReproductive Health and ContraceptionMenopause: Health Impacts and Treatments

Combined hormonal contraceptive use among obese women and risk for cardiovascular events: A systematic review

Horton, Leah G., Simmons, Katharine B., Curtis, Kathryn M.·2016·Contraception
DOI 10.1016/j.contraception.2016.05.014
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Abstract

Context Combined hormonal contraceptive (CHC) use may modify the risk of cardiovascular events in obese [body mass index (BMI) ≥30kg/m 2] women.Objective The objective was to evaluate from the literature whether CHC use modifies the risk of acute myocardial infarction (AMI), stroke, cerebral venous thrombosis (CVT) and venous thromboembolism (VTE) in obese women and to evaluate evidence for a dose-response relationship between BMI and VTE.Methods We searched PubMed for all articles published between database inception and February 2016 providing direct evidence on BMI, CHCs, and cardiovascular outcomes. We also searched for indirect evidence related to a dose-response relationship between BMI and risk of VTE in the general population, as these data were lacking for CHC users. The quality of each individual study was assessed using the system for grading evidence developed by the United States Preventive Services Task Force.Results The direct evidence search yielded 3 pooled analyses, 11 case-control studies and 1 cohort study. There was conflicting evidence about the risk of AMI or stroke among obese combined oral contraceptive (COC) users compared to obese nonusers, with one study finding no increased risk for AMI or stroke for COC users overall or stratified by BMI. A second study found significantly increased risk of AMI and stroke for COC users, with the highest risk estimates for high-BMI COC users. A single study suggested that obese COC users may be at higher risk for CVT compared with normal-weight nonusers. For VTE, obese COC users consistently had a risk that was 5 to 8 times that of obese nonusers and approximately 10 times that of nonobese nonusers. Five prospective cohort studies were identified as indirect evidence, and all found increased risk for VTE as BMI increased, suggesting a dose-response relationship between BMI and risk for VTE. No studies on the contraceptive patch or vaginal ring were identified that met the inclusion criteria.Conclusion Limited evidence of Level II-2, fair quality, concerning whether CHC use modifies the risk of AMI and stroke in obese women is inconclusive, while a single study of Level II-2, poor quality, found that obese COC users may be at higher risk for CVT compared with normal-weight nonusers. Both COC use and higher BMI increase risk for VTE, and the greatest relative risks are for those with both risk factors based on a body of evidence graded as Level II-2, fair to poor quality. It is not possible to estimate absolute risk of VTE among women with both of these risk factors; however, the absolute risk of VTE in healthy women of reproductive age is small.

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Authors
Horton, L. G., Simmons, K. B., & Curtis, K. M.
Affiliations
Centers for Disease Control and Prevention (US)
Corresponding author
Horton, Leah G.
ORCID
Venue
Contraception
Publisher
Elsevier BV
Published
2016-12
Volume
94
Issue
6
Pages
590-604
ISSN
0010-7824 (ISSN-L)
DOI
10.1016/j.contraception.2016.05.014
OpenAlex
W2414707773
Cited by
75
References
45
Citations by year
2026: 5 · 2025: 10 · 2024: 6 · 2023: 8 · 2022: 7 · 2021: 4 · 2020: 11 · 2019: 8 · 2018: 7 · 2017: 6 · 2016: 3
FWCI
1.38
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Contraception (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
Keywords
combined hormonal contraceptives, oral contraceptives, obesity, cardiovascular risk, acute myocardial infarction, stroke, cerebral venous thrombosis, venous thromboembolism, body mass index, dose-response relationship, contraceptive patch, vaginal ring, women of reproductive age
MeSH terms
Cardiovascular Diseases, Contraceptive Devices, Female, Contraceptives, Oral, Combined, Female, Humans, Myocardial Infarction, Obesity, Risk Factors, Body Mass Index, Risk Assessment, Stroke, Venous Thromboembolism

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