Myocardial infarction and stroke in young women: what is the impact of oral contraceptives?

Abstract

Recent discussions have centered on the small apparent risk increase for venous thromboembolism found with newer oral contraceptives (third-generation oral contraceptives containing the progestins desogestrel and gestodene) compared with older oral contraceptives (second-generation). This article reviews the studies addressing the association between oral contraceptive use and thromboembolic conditions affecting the arterial system, ischemic stroke, and myocardial infarction. Differences are found between a US database study, which showed no risk of ischemic stroke or myocardial infarction associated with low-dose oral contraceptive use, and the European studies, which showed oral contraceptive use in general to be associated with increased risks of ischemic stroke and myocardial infarction. The European studies showed no difference between oral contraceptive generations with respect to the occurrence of ischemic stroke; however, the risk of myocardial infarction associated with oral contraceptive use was consistently lower for third- than for second-generation oral contraceptives. Although there seems to be no differential risk of ischemic stroke associated with oral contraceptive generations, third-generation oral contraceptives appear to be consistently associated with no excess risk of myocardial infarction. In all instances, however, cardiovascular risk factors other than oral contraceptive use play the predominant role in the occurrence of ischemic stroke and myocardial infarction.

PIP: This article reviews seven recent studies that addressed the association between second- and third-generation oral contraceptive (OC) use and the risk of ischemic stroke and/or myocardial infarction. The one US study found no risk of ischemic stroke or myocardial infarction with low-dose OC use, while the European studies detected increased risks of both these events. The European studies showed no difference between OC generations in terms of the occurrence of ischemic stroke; however, the risk of myocardial infarction was consistently lower for third- compared with second-generation OCs. In all instances, cardiovascular risk factors other than OC use, especially smoking and hypertension, play the predominant role in the occurrence of both ischemic stroke and myocardial infarction.