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  • Title: Oral contraceptive use and myocardial infarction.
    Author: Petitti DB, Sidney S, Quesenberry CP.
    Journal: Contraception; 1998 Mar; 57(3):143-55. PubMed ID: 9617531.
    Abstract:
    Epidemiologic studies of current oral contraceptive (OC) use and myocardial infarction (MI) have been contradictory and confusing. This comprehensive review of the epidemiologic literature attempts to draw conclusions about the risk of myocardial infarction in oral contraceptive users, focusing on recent, methodologically rigorous studies of the topic. Recent studies are consistent in showing a higher relative risk of MI in current OC users who smoke compared with current OC users who do not smoke. Studies in aggregate suggest that the relative risk of MI is higher in current OC users with hypertension than in current OC users without hypertension. Recent studies do not show a relationship between higher estrogen dose and higher risk of MI, but the effect of estrogen dose and progestogen type and dose are difficult to separate. The limited data on the risk of MI in current users of low estrogen OC do not allow a firm conclusion about the possibility that progestogen type might affect the risk of MI in current users. Past OC use does not increase or decrease the risk of MI. Epidemiologic studies of the association between oral contraceptive (OC) use and the risk of myocardial infarction (MI) have produced conflicting results. Estimates of MI risk in current OC users have ranged from 0.87 to 5.01. However, many of these studies include serious methodologic flaws, including a restriction to idiopathic cases, failure to assess potential confounders such as smoking, and lack of attention to the problem of effect modification. This article is based on a comprehensive search of all studies published in 1960-97 that estimated the relative risk of MI or acute coronary artery disease in relation to past or current OC use and considered the effects of OC type, smoking, diabetes, a family history of MI, hypercholesterolemia, hypertension, age, and other risk factors. Studies that reported modification of the effect of current OC use by smoking consistently show higher relative risks than those that found no evidence of effect modification by smoking. Overall, the data suggest that the risk of MI for current OC use is probably increased by a factor of 1.2-1.8 in women who do not have high blood pressure and do not smoke. Current OC use in both smokers and women with high blood pressure is associated with a 5- to 10-fold increase in MI use compared to that of nonsmokers or nonhypertensive women who do not use OCs. There is no evidence of differences in the relative risk of MI between the different progestogens contained in OCs with less than 50 mcg of estrogen. Any conclusions about the relationship between OC formulation and MI risk remain tentative, however, as a result of small sample sizes, low power, inconsistency of results, and problems separating the effect of estrogen and progestogen type and dose.
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