Takaisin Tulosta

Risk of myocardial infarction in users of third generation oral contraceptives

Evidence summaries
Editors
4.11.2015

Level of evidence: C

Combined hormonal contraceptives containing under 50 micrograms of estrogen regardless of the type of the progestogen may not convey an increased risk of myocardial infarction compared with non-users of oral contraceptives.

According to the EMA’s Pharmacovigilance Risk Assessment «The EMA’s Pharmacovigilance Risk Assessment...»1 the risk of arterial thromboembolism (ATE, blood clots in arteries, which can potentially cause a stroke or heart attack) is very low with combined hormonal contraceptives. There is no evidence for a difference in the level of risk between products depending on the type of progestogen.

A Cochrane review «»1 «Roach RE, Helmerhorst FM, Lijfering WM et al. Comb...»2 included 24 case control studies estimating the risk of myocardial infarction or ischemic stroke in users compared with non-users of different types, doses and generations of combined oral contraception (COC) by a network meta-analysis. COC users were not at increased risk of myocardial infarction or ischemic stroke compared with non-users (OR 1.0, 95% CI 0.9 to 1.0). These ORs were similar for myocardial infarction alone (odds ratio, OR, 0.9, 95% CI 0.8 to 1.0) and ischemic stroke alone (OR 1.0, 95% CI 0.9 to 1.1). The risks did not vary according to the generation of progestagen or according to progestagen type. However, the risk of myocardial infarction or ischemic stroke was only increased in women using COCs containing ≥ 50 µg of estrogen.

References

  1. The EMA’s Pharmacovigilance Risk Assessment Committee Pharmacovigilance Risk Assessment Committee (PRAC). PRAC confirms that benefits of all combined hormonal contraceptives (CHCs) continue to outweigh risks EMA/607314/2013. «http://www.ema.europa.eu/ema/index.jsp?curl=pages/news_and_events/news/2013/10/news_detail_001916.jsp&mid=WC0b01ac058004d5c1»1
  2. Roach RE, Helmerhorst FM, Lijfering WM et al. Combined oral contraceptives: the risk of myocardial infarction and ischemic stroke. Cochrane Database Syst Rev 2015;(8):CD011054. «PMID: 26310586»PubMed