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Low-Dose Oral Contraceptive Use and the Risk of Myocardial Infarction
Lynn Rosenberg, ScD;
Julie R. Palmer, ScD;
R. Sowmya Rao, MS;
Samuel Shapiro, MB, FRCP(Edin)
Arch Intern Med. 2001;161:1065-1070.
Background Studies of oral contraceptives (OCs) containing 50 µg or more
of estrogen suggest an increased risk of myocardial infarction (MI) among
current users, particularly if they smoke heavily.
Objective To assess whether use of the newer lower-dose OCs increases the risk
of MI.
Methods A case-control study was conducted from January 1985 through March 1999
in 75 hospitals in the greater-Boston and greater-Philadelphia areas. Data
on OC use and MI risk factors were obtained by interview from 627 women with
a nonfatal first MI (cases) and 2947 female hospital controls younger than
45 years.
Results The overall odds ratio (OR) for current OC use relative to never used
was 1.3 (95% confidence interval [CI], 0.8-2. 2). The OR was elevated, 2.5
(95% CI, 0.9-7.5), among heavy smokers ( 25 cigarettes per day) but close
to 1.0 among lighter smokers (OR = 0.8) and nonsmokers (OR = 1.3). For current
OC use together with heavy smoking relative to nonuse and nonsmoking, the
OR was 32 (95 % CI, 12-81), considerably greater than that for heavy smoking
alone, 12 (95% CI, 8.6-16). The ORs did not vary according to the type of
formulation or the dose of estrogen; there were too few users to assess the
new 20-µg preparations. Past OC use was unrelated to risk.
Conclusion Current use of low-dose OCs in the United States is unrelated to an
increased risk of MI among nonsmokers and light smokers, but users who smoke
heavily may be at greatly increased risk.
From the Slone Epidemiology Unit, Boston University School of Public
Health, Brookline, Mass (Drs Rosenberg, Palmer, and Shapiro and Ms Rao); and
Columbia University School of Public Health, New York, NY (Dr Shapiro). The
Slone Epidemiology Unit has received support for other studies from the following
companies: Astra USA Inc, Bayer Corp, Bristol-Myers Squibb Co, Ciba-Geigy
Corp, Glaxo Wellcome Inc, Hoechst AG, Hoffmann-La Roche Inc, Johnson &
Johnson, Knoll Pharmaceutical Co, McNeil Pharmaceutical, Merck & Co Inc,
Marrion Merrell Dow Inc, Novartis Pharmaceuticals Corp, Ortho Biotech Inc,
Pfizer Inc, Procter & Gamble Pharamceuticals Inc, SmithKline Beecham Pharamceuticals,
Sterling Winthrop, Upjohn Co, Wallace Laboratories, and Warner-Lambert Co.
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