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Progestogen-Only Contraceptives and the Risk of Acute Myocardial Infarction: A Meta-Analysis
Study Questions:
Do progestogen-only contraceptives (POCs) increase the risk for myocardial infarction (MI)?
Methods:
This was a meta-analysis in which eligible articles were identified from MEDLINE and EMBASE. Criteria for inclusion included cohort or case-control studies, standardized criteria for MI, and clearly defined oral contraceptive use. Publications were excluded if they were non-English, on postmenopausal hormonal therapy, or were biological studies. Articles that were reviews or did not address MI risk were also excluded.
Results:
A total of 3,715 articles were identified, of which 3,643 did not meet eligibility criteria and were excluded. A further 44 studies were excluded as review articles, and 22 studies were excluded for not providing data on POC use. Of the remaining six articles, three studies were from Europe, two were from the United States, and one was worldwide. Age of participants in these studies ranged from 15 to 44 years. Subjects were exposed to oral POCs in four studies, and to oral or injectable POCs in one study and Norplant in one study. The combined odds ratio demonstrated no increase in risk for MI with POC use (odds ratio, 1.07; 95% confidence interval, 0.62-1.84). This relationship was similar for all types of POCs.
Conclusions:
The investigators concluded that POC use is not associated with increased risk of MI among currently available data.
Perspective:
As the authors point out, these results are based on observational data. Clinicians should be mindful that these data may not be generalizable to women with heart disease or at high risk for MI.
Keywords: Heart Diseases, Progestins, Risk, Myocardial Infarction, Contraceptives, Oral, Contraceptive Agents, Europe, United States
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