The effects of age, body mass index, smoking and general health on the risk of venous thromboembolism in users of combined oral contraceptives

Nightingale, Alison; Lawrenson, Ross; Simpson, Erroll T.; Williams, Tim; MacRae, K D; Farmer, Richard

doi:10.1080/13625180008500402

Cited by 120 publications

(48 citation statements)

References 17 publications

(16 reference statements)

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“…Obesity is a well-known risk factor of VTE [Nightingale et al 2000;Bergendahl et al 2012] and the increase in risk is about threefold. This increase is approximately of the same magnitude in COC users.…”

Section: Acquired Risk Factorsmentioning

confidence: 99%

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Combined hormonal contraceptives: prescribing patterns, compliance, and benefits versus risks

Brynhildsen

2014

Therapeutic Advances in Drug Safety

122

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Combined hormonal contraceptives [combined oral contraceptives (COCs)] have been available for over 50 years and the impact of this invention may not be overestimated. Today over 100 million women are current users and in Western Europe and the United States approximately 80% of women of fertile ages can be considered as ever-users. Over the years several drawbacks have been identified and media alarms on risks are frequently presented, resulting in suboptimal compliance and low compliance and continuation rates. Poor compliance and discontinuation is a big problem and is not generally identified by prescribers. During ideal use COCs offer very good protection against unwanted pregnancies, however there is a big problem with compliance and continuation and thus the 'real-life' efficacy is much lower. Reasons for poor compliance include side effects and fear of side effects and it is crucial that the prescriber gives the individual woman thorough and balanced information on the benefits and risks. Most well known is the increased risk of venous thromboembolism, but also an elevated risk of arterial thrombosis and several types of cancer has been reported. The risk estimates are low but according to the large number of users a substantial number of extra cases will occur. However, use of COCs also offers several additional health benefits with significant impact on morbidity and quality of life. COC use is associated with a substantial decrease in the risk of ovarian cancer, endometrial cancer and colorectal cancer. Moreover, COCs are a major option of treatment for women suffering from heavy menstrual bleeding and dysmenorrhea as well as hirsutism and acne vulgaris. The net effect of the additional health effects of COC-use may very well be positive, i.e. a slight increase in life expectancy.

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Section: Acquired Risk Factorsmentioning

confidence: 99%

“…The risk of VTE increases with age [Nightingale et al 2000;Bergendahl et al 2012]. A healthy, normal weight woman can be prescribed COC also during the ages 40-49 years but other potential risk factors must always be evaluated in relation to the age of the individual.…”

Section: Acquired Risk Factorsmentioning

confidence: 99%

Combined hormonal contraceptives: prescribing patterns, compliance, and benefits versus risks

Brynhildsen

2014

Therapeutic Advances in Drug Safety

122

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“…Six studies investigated patients Ͻ55 years of age. 12,36,40,41,43,50 Four of the studies involved only patients Ͼ45 years of age. 1,7,37,48 The mean age of the other studies ranged between 42 and 70 years.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…11,13,38,39,42,44 -47,49 As far as sex was concerned, 8 studies investigated only women, 13,36,39 -41,43,48,50 5 of these in the range of 15 to 50 years of age. 36,40,41,43,50 In 3 studies, only men were included. 7,12,37 All 4 cohort studies were prospective, 1,7,48,49 with a duration of follow-up between 5.6 48 and 26 years.…”

Section: Study Characteristicsmentioning

confidence: 99%

Cardiovascular Risk Factors and Venous Thromboembolism

et al. 2008

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Background-The concept that venous thromboembolism (VTE) and atherosclerosis are 2 completely distinct entities has recently been challenged because patients with VTE have more asymptomatic atherosclerosis and more cardiovascular events than control subjects. We performed a meta-analysis to assess the association between cardiovascular risk factors and VTE. Methods and Results-Medline and EMBASE databases were searched to identify studies that evaluated the prevalence of major cardiovascular risk factors in VTE patients and control subjects. Studies were selected using a priori defined criteria, and each study was reviewed by 2 authors who abstracted data on study characteristics, study quality, and outcomes. Odds ratios or weighted means and 95% confidence intervals (CIs) were then calculated and pooled using a random-effects model. Statistical heterogeneity was evaluated through the use of 2 and I 2 statistics. Twenty-one case-control and cohort studies with a total of 63 552 patients met the inclusion criteria. Compared with control subjects, the risk of VTE was 2.33 for obesity (95% CI, 1.68 to 3.24), 1.51 for hypertension (95% CI, 1.23 to 1.85), 1.42 for diabetes mellitus (95% CI, 1.12 to 1.77), 1.18 for smoking (95% CI, 0.95 to 1.46), and 1.16 for hypercholesterolemia (95% CI, 0.67 to 2.02). Weighted mean high-density lipoprotein cholesterol levels were significantly lower in VTE patients, whereas no difference was observed for total and low-density lipoprotein cholesterol levels. Significant heterogeneity among studies was present in all subgroups except for the diabetes mellitus subgroup. Higher-quality studies were more homogeneous, and significant associations remained unchanged. Conclusions-Cardiovascular

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“…CHCs contain both estrogen and a progestin and include combined oral contraceptives (COCs), the combined contraceptive vaginal ring and the combined transdermal contraceptive patch. Observational studies and meta-analyses have reported elevated risks of coronary heart disease, myocardial infarction (MI), stroke, venous thromboembolism (VTE) and peripheral arterial disease (PAD) among women who smoke and use CHCs [18][19][20][21][22][23][24][25][26][27][28][29]. The mechanisms underlying increased CVD risk in female smokers who use CHCs are poorly understood but could include effects of products of combustion, nicotine exposure or both.…”

Section: Introductionmentioning

confidence: 99%

Hormonal contraception among electronic cigarette users and cardiovascular risk: a systematic review

et al. 2016

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Background: Women who use combined hormonal contraceptives and cigarettes have an increased risk for cardiovascular (CV) events. We reviewed the literature to determine whether women who use hormonal contraceptives (HC) and electronic cigarettes (e-cigarettes) also have an increased risk. Study Design: Systematic review. Methods: We searched for articles reporting myocardial infarction (MI), stroke, venous thromboembolism, peripheral arterial disease or changes to CV markers in women using e-cigarettes and HC. We also searched for indirect evidence, such as CV outcomes among e-cigarette users in the general population and among HC users exposed to nicotine, propylene glycol or glycerol. Results: No articles reported on outcomes among e-cigarette users using HC. Among the general population, 13 articles reported on heart rate or blood pressure after e-cigarette use. These markers generally remained normal, even when significant changes were observed. In three studies, changes were less pronounced after e-cigarette use than cigarette use. One MI was reported among 1012 people exposed to ecigarettes in these studies. One article on nicotine and HC exposure found both exposures to be significantly associated with acute changes to heart rate, though mean heart rate remained normal. No articles on propylene glycol or glycerol and HC exposure were identified. Conclusion: We identified no evidence on CV outcomes among e-cigarette users using HC. Limited data reporting mostly acute outcomes suggested that CV events are rare among e-cigarette users in the general population and that e-cigarettes may affect heart rate and blood pressure less than conventional cigarettes. There is a need for research assessing joint HC and e-cigarette exposure on clinical CV outcomes.

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The effects of age, body mass index, smoking and general health on the risk of venous thromboembolism in users of combined oral contraceptives

Abstract: We believe that, before prescribing combined oral contraceptives, the venous as well as the arterial factors need to be considered and, in addition, age, obesity and smoking are all relevant when assessing an individual patient's risk.

Cited by 120 publications

References 17 publications

Combined hormonal contraceptives: prescribing patterns, compliance, and benefits versus risks

Combined hormonal contraceptives: prescribing patterns, compliance, and benefits versus risks

Cardiovascular Risk Factors and Venous Thromboembolism

Hormonal contraception among electronic cigarette users and cardiovascular risk: a systematic review

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