Background: Hormonal contraceptives are widely used for family planning and offer various therapeutic benefits. However, their long-term use, particularly in women with pre-existing cardiovascular risk factors, raises concerns about adverse outcomes. This study investigates the cardiovascular risks associated with hormonal contraceptive use, focusing on clinical, laboratory, and pathological findings and their implications for interventional cardiology. Methods: A cross-sectional study was conducted at the Hayatabad Medical Complex, Peshawar, Pakistan, from January 2023 to January 2024. A total of 102 female participants aged 20–50 years were included. Data on demographics, clinical history, and contraceptive use were collected using structured questionnaires. Clinical evaluations, laboratory tests, and imaging studies, including carotid intima-media thickness (IMT) and echocardiography, were performed. Pathological findings were recorded for participants undergoing relevant procedures. Statistical analyses were conducted to evaluate associations between contraceptive use and cardiovascular risks, with a significance threshold of p < 0.05. Results: The mean age of participants was 34.6 years, with an average BMI of 28.5 kg/m². Lifestyle factors included smoking (20% current, 30% past) and occasional alcohol consumption (45%). Hypertension (30%), diabetes mellitus (20%), and hyperlipidemia (40%) were prevalent. Combined oral contraceptives (COCs) were the most used method (50%), with 20% of participants on long-term use (>5 years). Cardiovascular outcomes included venous thromboembolism (15%), new-onset hypertension (20%), and stroke (10%). Laboratory findings revealed elevated CRP levels (3.5 mg/L) and IMT (0.85 mm). Pathological findings included vascular thrombi (12%), unstable plaques (40%), and inflammatory infiltrates (60%). Conclusion: This study underscores the significant cardiovascular risks associated with hormonal contraceptives, particularly in women with existing risk factors. Findings highlight the importance of personalized contraceptive counseling, regular cardiovascular monitoring, and early intervention to mitigate risks. Clinicians should balance the benefits of contraceptives with potential complications, ensuring safer alternatives for high-risk populations. Further research is needed to explore long-term outcomes and develop tailored risk management strategies.