What Role Does Stress Play?

In France, a woman dies every 7 minutes from cardiovascular disease (infarction, stroke, pulmonary embolism, etc.). In the United States, more than 400,000 women die from it each year, making heart disease the leading cause of death among women in the country. And yet, certain risk factors specific to women remain largely unknown. A new American study by the famous Mass General Brigham, published in JAMA Network Openfocuses on a sensitive subject: the link between hormonal contraception, psychiatric disorders linked to stress and cardiovascular risk.

When contraception meets stress

Used by more than nine million American women, hormonal contraception (pill, implant, etc.) modifies estrogen and progesterone levels. While its effects on cardiovascular health have already been examined, research generally focuses on young, healthy women. However, disorders associated with stress such as anxiety, depression or even post-traumatic stress syndrome (PTSD), common among middle-aged women, could change the situation: this is in any case the researchers’ initial hypothesis. The neurocardiac system, influenced by chronic stress, could in fact interact with contraceptive hormones and modify the body’s inflammatory or vascular response.

“Our study is the first to examine the combined effects of hormonal contraceptives and stress-related disorders on cardiovascular or thrombotic risk”explains its main author, Antonia Seligowski, in a interview published on the Mass General Brigham website. By analyzing medical data from more than 31,000 women, scientists discovered something surprising: “For the majority, including those with a history of anxiety or depression, hormonal contraceptive use was associated with a lower risk of major cardiovascular events.”. Chronic stress would therefore not come into play as much. With one exception, however: this benefit disappears in women suffering from PTSD, who do not benefit from this preventive effect linked to contraception.

A protective effect, except in cases of post-traumatic stress

These discoveries “suggest that cardiovascular risk may vary depending on the type of psychiatric disorder present in women using hormonal contraception”. The team of researchers is already planning clinical studies to explore the impact of contraceptive formulas on blood pressure, blood coagulation and even vascular health. “If these results are confirmed, health professionals will need to take into account psychiatric disorders associated with chronic stress when prescribing hormonal contraception”concludes Antonia Seligowski.