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  • Title: Oral contraceptives and myocardial infarction: new evidence leaves unanswered questions.
    Author: Thorogood M.
    Journal: Thromb Haemost; 1997 Jul; 78(1):334-8. PubMed ID: 9198175.
    Abstract:
    Early epidemiological studies showed that current use of oral contraceptives was associated with a two-to four-fold increase in risk of myocardial infarction. More recent studies indicate that the risk has fallen and is probably below two-fold, probably due both to changes in the formulations and to more cautious use of the preparations. There is inconclusive evidence of a small increase in risk associated with previous use of oral contraceptives. Myocardial infarction is rare in young women, particularly in the absence of clinical risk factors and cigarette smoking. It has been estimated that the population attributable risk is less than three events in one million women years. It has been suggested that preparations containing the newer progestogens, Desogestrel and Gestodene, are not associated with any increase in risk of myocardial infarction, but there is not yet sufficient evidence to test this hypothesis. Early epidemiologic studies indicated that current use of oral contraceptives (OCs) was associated with a 2- to 4-fold increase in the risk of myocardial infarction. Recent reductions in the estrogen dose of OC formulations and more cautious prescribing practices have reduced this risk to below 2-fold. Although sufficient evidence has not been accumulated, there are preliminary indications that third-generation OCs containing desogestrel or gestodene confer no increased risk of myocardial infarction. Studies examining the risk of past OC use of at least 5 years' duration have produced conflicting results. Since myocardial infarction is rare among young women, especially in the absence of cigarette smoking and clinical risk factors, the population attributable risk may be less than 3 events in 1 million woman-years.
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