Real-World Assessment of Cardiovascular Risk Factors Among Women with a Combined Hormonal Contraception Prescription in the United States: An Electronic Health Records Study

OBJECTIVES: Combined Hormonal Contraceptive (CHC) users are at a higher risk of cardiovascular diseases (CVD) than non-users, and their prescription in women with multiple risk factors for atherosclerotic CVD is unadvisable according to the U.S. Medical Eligibility Criteria for Contraceptive Use (USMEC). These risk factors are categorized as medical conditions when theoretical or proven risks usually outweigh advantages (USMEC category 3 contraindication) or conditions with unacceptable health risk if used (USMEC category 4 contraindication). This study aims to investigate the prevalence of these cardiovascular risk factors and their association among women with CHC prescriptions in the US.

METHODS: This cross-sectional study included women from the Oracle EHR Real World Data aged 18-55 with at least one CHC prescription between 2021-2023. Index date was the date of the first prescription identified during the period and the presence of risk factors for CVD was assessed in the 2-year pre-index period.

RESULTS: A total of 817,048 women were enrolled, with a mean age in years of 30 (standard deviation (SD): 9.09), a mean body mass index (BMI) of 31.01 (SD:8.34), and they were mostly white (70%, n=570,564). One out of four women (24%, n=199,772) had at least one cardiovascular risk factor, the most frequent was obesity in 22% (n=179,208) of women, hypertension in 3% (n= 27,090), hyperlipidemia in 2% (n= 16,981), and diabetes in 2% (n= 15,850). The combination of at least 2 cardiovascular risk factors was found in 4% (n= 35,074) of patients, representing a USMEC 3/4 contraindication.

CONCLUSIONS: These results found an important prevalence of cardiovascular risk factors among women with CHC prescriptions. This underscores the importance of comprehensive cardiovascular risk factor screening at initiation and during follow-up for the identification of an optimal contraceptive method given the patient’s individual risks for preventing CVDs.