Hormonal Contraceptive Use, Stress Disorders, and Cardiovascular and Thrombotic Risk in Women

Area of Science:

• Cardiovascular Health
• Psychiatric Disorders
• Women's Health

Background:

• Stress and psychiatric conditions like depression, anxiety, and PTSD significantly impact women's cardiovascular health.
• Research on the interplay between sex-specific factors, such as hormonal contraceptive use, and these psychiatric conditions is limited.

Purpose of the Study:

• To investigate whether psychiatric diagnoses related to stress modify the association between hormonal contraceptive use and cardiovascular/thrombotic risk.
• To explore the specific impact of depression, anxiety, and PTSD on cardiovascular outcomes in women using hormonal contraceptives.

Main Methods:

• Retrospective cohort study utilizing electronic health records from a US hospital-based biobank.
• Included 31,824 women aged 18-55 with data analyzed from May 2024 to November 2025.
• Assessed history of depression, anxiety, PTSD, and combined hormonal contraceptive use, examining major adverse cardiovascular events (MACE) and deep-vein thrombosis (DVT).

Main Results:

• Combined hormonal contraceptive use was associated with lower MACE risk in women without PTSD.
• Depression and anxiety did not moderate the association between contraceptive use and MACE or DVT.
• Posttraumatic stress disorder (PTSD) modified the association between contraceptive use and MACE, with higher odds of MACE in women with PTSD using contraceptives, though not statistically significant.

Conclusions:

• Combined hormonal contraceptive use shows a protective association with cardiovascular risk in women with depression or anxiety.
• This protective effect was not observed in women with PTSD, highlighting unique cardiovascular considerations.
• Further research is warranted to elucidate the distinct cardiovascular processes in women with PTSD who use hormonal contraceptives.