The combined birth control pill is linked to a 24-fold increased risk of venous thromboembolism (VTE) in obese women compared with women who are not obese, researchers say today.
A review paper published in today’s *ESC Heart Failure* highlights the latest evidence on the independent effects of obesity and contraceptives, and their synergistic effects, on VTE risk and provides clinical recommendations.
Study author Professor Giuseppe Rosano, of the IRCCS San Raffaele Pisana, Rome, Italy, said: “It is well established that both obesity and oestrogen-containing contraceptives are risk factors for VTE.
“Despite this, obese women continue to receive these drugs. The scientific evidence indicates that obesity and combined oral contraceptives have a synergistic effect on VTE risk and this should be considered in prescribing decisions.
“Progestin-only products, including pills, intrauterine devices, or implants are a safer alternative to the combined pill in women carrying excess weight.”
The risk of VTE increases progressively with body mass index (BMI), and in obese women it is more than double that of non-obese women.
Obesity has the most substantial impact on VTE women under 40 years of age, who have a five-fold increased risk compared with non-obese women.
Combined oral contraceptives are associated with an elevated likelihood of VTE, with users having a three- to seven-fold elevated likelihood of VTE compared with non-users. However, progestin-only products are not associated with an increased risk of VTE.
A large population-based study found that being overweight and obese were associated with 1.7-fold and 2.4-fold increased risks of VTE, respectively. However, in combined pill users, VTE risk was 12-fold higher in overweight women and 24-fold higher in obese women, when compared with normal weight non-users.
Prof Rosano said: “Obese women taking contraceptives are vulnerable to VTE and should take steps to limit their other predisposing factors for cardiovascular disease, for example by quitting smoking and increasing their physical activity levels.”
Rosano GMC, Rodriguez-Martinez MA, Spoletini I, Regidor PA. Obesity and contraceptive use: impact on cardiovascular risk. *ESC Heart Fail*. 15 September 2022; doi:10.1002/ehf2.14104.
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