Antonia Seligowski, PhD, a senior researcher in the Neurocardiac Effects of Stress & Trauma Laboratory within the Department of Psychiatry at Mass General Brigham, is the senior author of a recent study published in JAMA Network Open titled “Hormonal contraceptive use, stress disorders, and cardiovascular and thrombotic risk in women.”
Why is this study important?
Cardiovascular disease (CVD) remains the leading cause of death in the United States, claiming the lives of more than 400,000 women annually. Psychological stress is a well-established contributor to CVD risk, and stress-related psychiatric conditions such as anxiety and post-traumatic stress disorder (PTSD) occur more frequently in women. These realities have prompted increasing calls for research that addresses sex-specific contributors to cardiovascular health.
Hormonal contraceptives, used by approximately 9.1 million women nationwide, represent one such factor. These medications alter endogenous hormone levels by suppressing estradiol and progesterone. However, most previous studies have focused on younger, healthier populations, leaving a significant knowledge gap regarding women with stress-related psychiatric disorders. To our knowledge, this study is the first to evaluate the combined influence of hormonal contraceptive use and stress-related conditions on cardiovascular and thrombotic risk.
What questions did the study address?
Led by Jordan Thomas, PhD, from the University of Kansas, the study examined whether hormonal contraceptive use is associated with cardiovascular and thrombotic outcomes in women with and without stress-related psychiatric disorders. Specifically, we assessed the risk of major adverse cardiovascular events (MACE) and deep-vein thrombosis among contraceptive users with histories of depression, anxiety, or PTSD.
How was the study conducted?
We analyzed electronic health records from 31,824 women enrolled in the Mass General Brigham Biobank. The analysis included diagnostic codes for stress-related psychiatric conditions, cardiovascular events, thrombotic outcomes, and documented hormonal contraceptive prescriptions.
What were the key findings?
Hormonal contraceptive use was associated with a reduced risk of MACE in most women, including those with anxiety or depression. However, this protective association was not observed in women with PTSD. These preliminary findings suggest that cardiovascular risk related to hormonal contraceptive use may differ based on stress-related psychiatric history.
What comes next?
Future research will focus on prospective clinical studies examining specific contraceptive formulations and their effects on cardiovascular risk factors such as blood pressure, vascular function, and clotting markers. We also aim to determine whether these effects differ among women with and without stress-related psychiatric disorders through long-term follow-up.
