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Cited by 367Reproductive Health and ContraceptionAcute Myocardial Infarction ResearchBlood Coagulation and Thrombosis Mechanisms

Oral Contraceptives and the Risk of Myocardial Infarction

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Tanis, Bea C., van den Bosch, Maurice A.A.J., Kemmeren, Jeanet M., Cats, Volkert Manger, Helmerhorst, Frans M., Algra, Ale, van der Graaf, Yolanda, Rosendaal, Frits R.·2001·New England Journal of Medicine
DOI 10.1056/nejmoa003216
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Abstract

BACKGROUND: An association between the use of oral contraceptives and the risk of myocardial infarction has been found in some, but not all, studies. We investigated this association, according to the type of progestagen included in third-generation (i.e., desogestrel or gestodene) and second-generation (i.e., levonorgestrel) oral contraceptives, the dose of estrogen, and the presence or absence of prothrombotic mutations METHODS: In a nationwide, population-based, case-control study, we identified and enrolled 248 women 18 through 49 years of age who had had a first myocardial infarction between 1990 and 1995 and 925 control women who had not had a myocardial infarction and who were matched for age, calendar year of the index event, and area of residence. Subjects supplied information on oral-contraceptive use and major cardiovascular risk factors. An analysis for factor V Leiden and the G20210A mutation in the prothrombin gene was conducted in 217 patients and 763 controls RESULTS: The odds ratio for myocardial infarction among women who used any type of combined oral contraceptive, as compared with nonusers, was 2.0 (95 percent confidence interval, 1.5 to 2.8). The adjusted odds ratio was 2.5 (95 percent confidence interval, 1.5 to 4.1) among women who used second-generation oral contraceptives and 1.3 (95 percent confidence interval, 0.7 to 2.5) among those who used third-generation oral contraceptives. Among women who used oral contraceptives, the odds ratio was 2.1 (95 percent confidence interval, 1.5 to 3.0) for those without a prothrombotic mutation and 1.9 (95 percent confidence interval, 0.6 to 5.5) for those with a mutation CONCLUSIONS: The risk of myocardial infarction was increased among women who used second-generation oral contraceptives. The results with respect to the use of third-generation oral contraceptives were inconclusive but suggested that the risk was lower than the risk associated with second-generation oral contraceptives. The risk of myocardial infarction was similar among women who used oral contraceptives whether or not they had a prothrombotic mutation.

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  • In a study of oral contraceptives and myocardial infarction, a sample of young women with infarction more often had risk factors for that disease, such as high serum cholesterol, smoking and a positive family history, than the control group.

    “For example, in a study of oral contraceptives and myocardial infarction, a sample of young women with infarction more often had risk factors for that disease, such as high serum cholesterol, smoking and a positive family history, than the control group [ 146 ].”

    From Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): Explanation and Elaboration (2007) · cites this paper as [146]

  • In women with dyslipidaemia, users of combined hormonal contraceptive agents are at increased risk of myocardial infarction compared with non-users.

    “Similarly, in women with dyslipidaemia,80 results derived from one primary study reported in the systematic review showed that users of combined hormonal contraceptive agents were at an increased risk of myocardial infarction82 and cerebrovascular accident compared with non-users (table 1).83”

    From Association between the reproductive health of young women and cardiovascular disease in later life: umbrella review (2020) · cites this paper as [82]

  • Current oral contraceptive use is associated with temporary increased blood pressure and a potentially elevated risk of developing vascular disease later in life.

    “Additionally, current oral contraceptive use, which also alters the hormonal milieu, is associated with temporary increased blood pressure, as well as a potentially elevated risk of developing vascular disease later in life.(3–5)”

    From Infertility, fertility treatment, and risk of hypertension (2015) · cites this paper as [5]

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Authors
Tanis, B. C., van den Bosch, M. A. A. J., Kemmeren, J. M., Cats, V. M., Helmerhorst, F. M., Algra, A., van der Graaf, Y., & Rosendaal, F. R.
Affiliations
  • Leiden University Medical Center (NL)
  • University Medical Center Utrecht (NL)
ORCID
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
2001-12-20
Volume
345
Issue
25
Pages
1787-1793
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejmoa003216
OpenAlex
W2393373959
Cited by
367
References
51
Citations by year
2026: 4 · 2025: 4 · 2024: 13 · 2023: 8 · 2022: 8 · 2021: 12 · 2020: 10 · 2019: 7 · 2018: 10 · 2017: 10 · 2016: 20 · 2015: 16 · 2014: 13 · 2013: 15 · 2012: 18
FWCI
29.69
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
  • Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
Keywords
oral contraceptives, myocardial infarction, progestogens, desogestrel, gestodene, levonorgestrel, estrogen dose, factor V Leiden, prothrombin G20210A, prothrombotic mutations, cardiovascular risk, women
MeSH terms
Adolescent, Adult, Contraceptives, Oral, Ethinyl Estradiol, Factor V, Female, Humans, Middle Aged, Myocardial Infarction, Norpregnenes, Prothrombin, Risk Factors, Smoking, Logistic Models, Odds Ratio, Case-Control Studies, Levonorgestrel, Desogestrel, Point Mutation

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