Oral Contraceptives and the Risk of Myocardial Infarction

Abstract

Back-ground An association between the use of oral contraceptives and the risk of myocardial infarction has been found in some, but not all, studies. We investigated this association, according to the type of progestagen included in third-generation (i.e., desogestrel or gestodene) and second-generation (i.e., levonorgestrel) oral contraceptives, the dose of estrogen, and the presence or absence of prothrombotic mutations. Methods In a nationwide, population-based, casecontrol study, we identified and enrolled 248 women 18 through 49 years of age who had had a first myocardial infarction between 1990 and 1995 and 925 control women who had not had a myocardial infarction and who were matched for age, calendar year of the index event, and area of residence. Subjects supplied Information on oral-contraceptive use and major cardiovascular risk factors. An analysis for factor V Leiden and the G20210A mutation in the prothrombin gene was conducted in 217 patients and 763 controls.Results The odds ratio for myocardial infarction among women who used any type of combined oral contraceptive, äs compared with nonusers, was 2.0 (95 percent confidence interval, 1.5 to 2.8). The adjusted odds ratio was 2.5 (95 percent confidence interval, 1.5 to 4.1) among women who used second-generation oral contraceptives and 1.3 (95 percent confidence interval, 0.7 to 2.5) among those who used third-generation oral contraceptives. Among women who used oral contraceptives, the odds ratio was 2.1 (95 percent confidence interval, 1.5 to 3.0) for those without a prothrombotic mutation and 1.9 (95 percent confidence interval, 0.6 to 5.5) for those with a mutation. Conclusions The risk of myocardial infarction was increased among women who used second-generation oral contraceptives. The results with respect to the use of third-generation oral contraceptives were inconclusive but suggested that the risk was Iower than the risk associated with second-generation oral contraceptives. The risk of myocardial infarction was similar among women who used oral contraceptives whether or not they had a prothrombotic mutation. Later studies established the use of oral contraceptives äs a risk factor for venous äs well äs arterial thrombosis. 2 7 Various modifications were made in an attempt to Iower these risks, including a reduction in the estrogen dose and changes in the progestagen compound. Oral contraceptives containing an estrogen and the progestagen desogestrel or gestodene, available since the 1980s, are associated with at least a doubling of the risk of venous thrombosis äs compared with other combined oral contraceptives. 812 It has been suggested that these third-generation contraceptives protect against myocardial infarction by having a favorable effect on the lipid profile, 131S because studies showed that women who used these types had a slight increase in the level of high-density lipoprotein cholesterol. 15 · 16 Only a few studies of the association between oral contraceptives and myocardial infarction have included a direct compar...

Determinants of oral contraception use in a southern European setting

“…With regard to safety, migraine per se is not a contraindication for use of the pill 17 . Our results also show that women with high cholesterol levels are less likely to use OCs, probably because clinicians take conventional risk factors for cardiovascular events into consideration before prescribing these 18 .…”

Increased plasma viscosity in young women with polycystic ovary syndrome using an oral contraceptive containing 35 μg ethinyl estradiol and 2 mg cyproterone acetate

“…But OCs are not free of adverse effects, the most serious of which concern the cardiovascular system. Although data concerning 1st and 2nd generation OC formulations consistently demonstrate small but significantly elevated risk of myocardial infraction (MI) and venous thromboembolism (VTE) among current users, past use of OCs and 3rd generation formulations are associated with a reduction/no elevation in risk [34][35][36].…”

FSRH Guideline (April 2019) Overweight, Obesity and Contraception

“…This review included one pooled analysis183 and one case-control study184 of MI and one pooled analysis185 and one case-control study186 of stroke. The pooled analyses of case-control data found no increased risk for MI or stroke for COC users overall or stratified by BMI,183,185 whereas the other case-control studies that were included in the systematic review found significantly increased risk of MI184 and ischaemic stroke186 for obese COC users compared to normal-weight non-users, with the highest risk estimates for high-BMI COC users. These studies were of fair quality with diagnostic criteria for MI and stroke and adjustment for confounders, but with self-reported weight and height and inadequately systematic inclusion of MI and stroke fatalities, which could have led to bias.…”