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  • Title: Progestogens in cardiovascular diseases: an introduction to the epidemiologic data.
    Author: Mann JI.
    Journal: Am J Obstet Gynecol; 1982 Mar 15; 142(6 Pt 2):752-7. PubMed ID: 7065056.
    Abstract:
    Earlier publications on the cardiovascular risks associated with oral contraceptive use emphasized the role of estrogens. Today most oral contraceptives contain less tha 50 microgram of estrogen. Furthermore, prescribing practices have improved so that most women with risk factors are not taking oral contraceptives. No differences in risk of fatal myocardial infarctions could be demonstrated by women taking 50 microgram estrogen products versus those taking products with lower estrogen dosages. Perhaps this result reflects small numbers of patients in the study, or perhaps it reflects an effect of progestogen. Since the lower estrogen doses are associated with levonorgestrel, the possibility exists that the advantages of reduced estrogen dosage are masked by the progestogen effect. A larger study is required to examine the relative importance of the estrogen and progestogen components in combined oral contraceptives. An Oxford study reexamines the association between oral contraceptives (OCs) and myocardial infarction by examining copies of death certificates received for 248 women who were coded as dying of myocardial infarction. The general practitioner (GP) for each woman in the study was contacted and asked to provide data regarding her medical and family history, smoking habits, and OC use. The GP was also requested to randomly select by a defined procedure 2 female controls matched by age and marital status. 139 GPs returned complete information on the deceased patient and on 2 controls, and these data formed the basis of the analysis. Slightly more than 1/3 of the current (at time of death for cases and at time of death of the relevant case for each control) users were taking preparations containing less than 50 mcg estrogen. Relative risk of infarction for all current OC users as compared with nonusers was not statistically significant. Although data on smoking are incomplete, smoking appeared to be significantly more common in the deceased patients. Of 79 patients with available data, 63 (80%) were smokers versus 29 (33%) of the 89 controls. All risk factors considered (diabetes, hyperlipidemia, hypertension, preeclamptic toxemia of pregnancy, symptomatic angina) were more common in deceased patients than in controls. Current OC use was unusual in women known to be at increased risk of infarction but more common in those defined as not having a major risk factor for myocardial infarction--26% of patients and 16% of controls. In this group, the simple relative risk of infarction for current users was 2.2:1 (p0.02). No significant difference was seen between the relative risk estimates for current use of preparations containing either 50 mcg or less of estrogen. No increased risk was seen in association with past OC use. This study shows no differences in risk of fatal infarction in women taking 50 mcg estrogen products and those taking lower estrogen products. As the lower estrogen doses are associated with levenorgestrel, it is possible that the advantages of reduced estrogen dosage are masked by the progestogen effect. A larger study should be done to determine the relative importance of the estrogen and progestogen components in OCs.
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