Mumbai woman's heart attack linked to oral contraceptives: How does long-time pill use raise risks?
A 27-year-old woman in Mumbai suffered a heart attack with no marked risk factors except that she was taking contraceptive pills to deal with her polycystic ovarian syndrome (PCOS), a hormonal disorder causing irregular periods and cysts in the ovaries. She had been living with this condition for 10 years and had been on the pill for seven years. What she didn't know is that prolonged use of pills can often lead to blood clots that can trigger a heart attack.
While oral contraceptives are recommended to PCOS patients to regulate irregular periods and male hormones, prevent thickening of the uterus walls and provide symptomatic relief, they also affect the heart. Many patients ask me, since estrogen is cardio-protective and oral contraceptives also contain it, why should there be a risk? The fact is that oral estrogen therapy comes with risks.
How do oral estrogen pills increase risk of heart disease?
Oral contraceptives containing estrogen can increase the risk of heart attacks by increasing the risk of blood clots (thrombosis), which can lead to blockages in arteries, potentially resulting in a heart attack. They also raise blood pressure, a known risk factor for heart disease, and alter blood cholesterol levels. In other words, oral estrogen pills can elevate LDL or low-density lipoprotein (bad) cholesterol and lower HDL or high-density lipoprotein (good) cholesterol, further increasing the risk of heart disease.
Estrogen increases clotting, which happens in many parts of the body, some of which could be lethal. For example, blood clots could form in one of the deep veins in the legs, arms or pelvis, obstructing blood flow and causing localised swelling and pain. If the clot dislodges and travels to the lungs, it could cause embolism or blockage of blood channels there, reducing oxygen supply and stressing both the heart and lungs. Such clots can also trigger brain strokes.
A study found that the use of oral contraceptives is associated with approximately a two-fold and over four-fold increased relative risk of clotting in arteries and veins.
Which women are most at risk?
The risk of heart attack associated with oral contraceptives is higher for women older than 35, smokers and those with other heart disease risk factors like high blood pressure, diabetes, high haemoglobin levels and very high counts of platelets.
What are preventive measures?
If you have been advised oral contraceptives for PCOS, then simultaneously meet a cardiologist and get your heart risk factors assessed. Anything underlying will show up. Oral anticoagulants should be prescribed when there are signs of blood circulation issues like leg swelling.
While oral contraceptives containing estrogen pose a higher risk, progestin-only pills have a lower risk and may be a better alternative for some women.
(Dr Singh is Chairman, Cardiac Sciences, Max Healthcare)
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