Speciality
Spotlight

 




 


Cardiology


 


   





Contraception

       

  • Myocardial Infarction and Use of Low-dose oral contraceptives; A Pooled
    Analysis of 2 US Studies.



    S Sidney, et al (Kaiser Permanente med Care Program,
    Northern California: Univ of Washington, Seattle;

     Natl Inst of Child Health and Human Development,
    Bethesda, Md; et al)


    Circulation
    98:1-6, 1998.



       


    Conclusion: 
    There was no evidence of increased risk of
    myocardial infarction with OC use in either study,
    even though the number of smokers, those with risk
    factors for cardiovascular disease, and those older
    than 40 were small.

       

    Oral
    contraceptives with 50mg of estrogen or more were
    associated with an increased risk of myocardial
    infarction (MI) in women who smoked cigarettes, but
    not in nonsmokers. 
    The etiology of the MI in these women was
    enhanced thrombosis, not atherosclerosis. 
    The thrombophillic effects of Ocs
    are directly related to the amount of estrogen in
    the formulation. 
    Nearly all Ocs
    now used in the United States have between 20 and
    35mg of estrogen. 
    Furthermore, in the US, Ocs
    are not currently prescribed to women older than 35
    who smoke cigarettes or to those of any age with
    uncontrolled hypertension. 
    As shown in this analysis, use of these
    low-dose formulations and avoidance of OC use in
    women with certain risk factors for MI appears to
    have eliminated any increased risk of MI with OC
    use. 
    It remains to be determined whether the
    decreased risk of MI associated with past use of Ocs
    is casually related to their use.

        

  • NR
    Poulter, for the World Health Organization
    Collaborative study of Cardiovascular Disease and
    Steroid Hormone Contraception (St Mary’s Hosp.
    London)

    Cardiovascular Disease and Use of Oral and Injectable Progestogen only
    Contraceptives and Combined Injectable
    Contraceptives: Results of an International
    Multicenter, Case-Control Study.

      

    Contraception 57:315-324, 1998.

       

    Conclusion: 
    There is little or no increased risk of
    stroke, venous thromboembolism, or acute myocardial
    infarction associated with the use of oral or
    injectable progestogen-only contraceptives or
    combined injectable contraceptives.

       

    There
    may be a need, however, for further studies on the
    possible adverse effects on stroke risk of
    progestogen-only contraceptives taken by women with
    a history of high blood pressure.

      

    The
    mechanism whereby combined oral contraceptives
    increase the risk of venous thrombosis as well as
    ischemic stroke and myocardial infarction in women
    with risk factors is from a thrombophillic action of
    the estrogen component of these agents. 
    Because the progestin component, unlike
    ethinyl estradiol, does not increase hepatic
    synthesis of globulins involved in the coagulation
    process, one would not expect the use of progestin-only
    contraceptives would increase the risk of having an
    adverse cardiovascular event. 
    The results of this large epidemiologic study
    provide data indicating use of either oral or
    injectable steroid contraceptives containing a
    progestin without estrogen is not associated with a
    significantly increased risk of venous thrombosis,
    stroke, or myocardial infarction. 
    Although product labeling states progestin-only
    contraceptives should not be used in women with a
    history of venous thrombosis, no data indicate that
    these agents alter the risk of venous thrombosis
    among women with a history of this disorder.

      




 

 

Speciality Spotlight

 

   

Contraception
       

  • Myocardial Infarction and Use of Low-dose oral contraceptives; A Pooled Analysis of 2 US Studies.

    S Sidney, et al (Kaiser Permanente med Care Program, Northern California: Univ of Washington, Seattle;
     Natl Inst of Child Health and Human Development, Bethesda, Md; et al)
    Circulation 98:1-6, 1998.
       
    Conclusion:  There was no evidence of increased risk of myocardial infarction with OC use in either study, even though the number of smokers, those with risk factors for cardiovascular disease, and those older than 40 were small.
       
    Oral contraceptives with 50mg of estrogen or more were associated with an increased risk of myocardial infarction (MI) in women who smoked cigarettes, but not in nonsmokers.  The etiology of the MI in these women was enhanced thrombosis, not atherosclerosis.  The thrombophillic effects of Ocs are directly related to the amount of estrogen in the formulation.  Nearly all Ocs now used in the United States have between 20 and 35mg of estrogen.  Furthermore, in the US, Ocs are not currently prescribed to women older than 35 who smoke cigarettes or to those of any age with uncontrolled hypertension.  As shown in this analysis, use of these low-dose formulations and avoidance of OC use in women with certain risk factors for MI appears to have eliminated any increased risk of MI with OC use.  It remains to be determined whether the decreased risk of MI associated with past use of Ocs is casually related to their use.
        

  • NR Poulter, for the World Health Organization Collaborative study of Cardiovascular Disease and Steroid Hormone Contraception (St Mary’s Hosp. London)
    Cardiovascular Disease and Use of Oral and Injectable Progestogen only Contraceptives and Combined Injectable Contraceptives: Results of an International Multicenter, Case-Control Study.
      
    Contraception 57:315-324, 1998.
       
    Conclusion:  There is little or no increased risk of stroke, venous thromboembolism, or acute myocardial infarction associated with the use of oral or injectable progestogen-only contraceptives or combined injectable contraceptives.
       
    There may be a need, however, for further studies on the possible adverse effects on stroke risk of progestogen-only contraceptives taken by women with a history of high blood pressure.
      
    The mechanism whereby combined oral contraceptives increase the risk of venous thrombosis as well as ischemic stroke and myocardial infarction in women with risk factors is from a thrombophillic action of the estrogen component of these agents.  Because the progestin component, unlike ethinyl estradiol, does not increase hepatic synthesis of globulins involved in the coagulation process, one would not expect the use of progestin-only contraceptives would increase the risk of having an adverse cardiovascular event.  The results of this large epidemiologic study provide data indicating use of either oral or injectable steroid contraceptives containing a progestin without estrogen is not associated with a significantly increased risk of venous thrombosis, stroke, or myocardial infarction.  Although product labeling states progestin-only contraceptives should not be used in women with a history of venous thrombosis, no data indicate that these agents alter the risk of venous thrombosis among women with a history of this disorder.
      

 

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