Cardiovascular disease and use of oral and injectable progestogen-only contraceptives and combined injectable contraceptives. Results of an international, multicenter, case-control study. World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception
- PMID: 9673838
Cardiovascular disease and use of oral and injectable progestogen-only contraceptives and combined injectable contraceptives. Results of an international, multicenter, case-control study. World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception
Abstract
This report describes the first study to evaluate the risks of cardiovascular disease (CVD) associated with the use of oral and injectable progestogen-only and combined injectable contraceptives. Based on combined data from Africa, Asia, Europe, and Latin America collected in the World Health Organization (WHO) Collaborative Study, odds ratios (OR) for CVD combined, strokes, venous thromboembolism (VTE), and acute myocardial infarction (AMI) were calculated. Among 3697 CVD cases (59% stroke, 31% VTE, and 10% AMI), 53, 37, and 13 women, respectively, were current users of oral and injectable progestogen-only and combined injectable contraceptives. Overall, the adjusted OR for all CVD combined compared with nonusers of any type of steroid hormone contraceptive (SHC) associated with current use of oral and injectable progestogen-only contraceptives and combined injectable contraceptives, respectively, were 1.14 (95% CI: 0.79-1.63), 1.02 (0.68-1.54), and 0.95 (0.49-1.86). No significant changes in OR were apparent for strokes, VTE, or AMI in association with any of these types of contraception. However, a small, nonsignificant increase in OR for VTE was apparent in association with oral and injectable progestogen-only contraceptives. Among women with a history of hypertension, OR for stroke, as compared with that for nonusers of any type of SHC with no history of hypertension, rose from 7.2 (6.1-8.5) among nonusers of any type of SHC to 12.4 (4.1-37.6) among current users of all oral progestogens. Although limited by the small number of cases and control subjects using the types of contraceptives under investigation, these data suggest that there is little or no increased risk of stroke, VTE, or AMI associated with the use of oral or injectable progestogen-only or combined injectable contraceptives. However, further investigation into a possible adverse effect on stroke risk of progestogen-only contraceptives used by women with a history of high blood pressure are indicated.
Similar articles
-
Cardiovascular disease and steroid hormone contraception. Report of a WHO Scientific Group.World Health Organ Tech Rep Ser. 1998;877:i-vii, 1-89. World Health Organ Tech Rep Ser. 1998. PMID: 9615606 Review.
-
Acute myocardial infarction and combined oral contraceptives: results of an international multicentre case-control study. WHO Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception.Lancet. 1997 Apr 26;349(9060):1202-9. Lancet. 1997. PMID: 9130941
-
Oral contraceptive pills and the risk of venous thromboembolism.Prog Hum Reprod Res. 1996;(39):2-3. Prog Hum Reprod Res. 1996. PMID: 12292198
-
Recent studies confirm the safety of oral contraceptives with respect to stroke.Contracept Rep. 1996 Nov;7(4):4-9. Contracept Rep. 1996. PMID: 12291813
-
Depo Provera. Position paper on clinical use, effectiveness and side effects.Br J Fam Plann. 1999 Jul;25(2):69-76. Br J Fam Plann. 1999. PMID: 10454658 Review.
Cited by
-
U.S. Medical Eligibility Criteria for Contraceptive Use, 2024.MMWR Recomm Rep. 2024 Aug 8;73(4):1-126. doi: 10.15585/mmwr.rr7304a1. MMWR Recomm Rep. 2024. PMID: 39106314 Free PMC article.
-
Pulmonary Hypertension in Pregnancy: A Review.Medicina (Kaunas). 2021 Mar 11;57(3):259. doi: 10.3390/medicina57030259. Medicina (Kaunas). 2021. PMID: 33799910 Free PMC article. Review.
-
Health care providers' knowledge about contraceptive evidence: a barrier to quality family planning care?Contraception. 2010 Apr;81(4):292-8. doi: 10.1016/j.contraception.2009.11.006. Epub 2009 Dec 11. Contraception. 2010. PMID: 20227544 Free PMC article.
-
Association of Progestogens and Venous Thromboembolism Among Women of Reproductive Age.Obstet Gynecol. 2022 Sep 1;140(3):477-487. doi: 10.1097/AOG.0000000000004896. Epub 2022 Aug 3. Obstet Gynecol. 2022. PMID: 35926206 Free PMC article.
-
Effect of injectable and oral contraceptives on serum lipids.Obstet Gynecol. 2009 Oct;114(4):786-794. doi: 10.1097/AOG.0b013e3181b76bea. Obstet Gynecol. 2009. PMID: 19888036 Free PMC article.
Publication types
MeSH terms
Substances
Grants and funding
LinkOut - more resources
Full Text Sources
Other Literature Sources
Miscellaneous