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Chiropractic Research Review

Oral Contraceptives Double Heart-Attack Risk

Studies have shown a link between oral-contraceptive (OC) use and risk for myocardial infarction, which has prompted the production of new OCs intended to neutralize negative side effects. These third-generation contraceptives have been suggested to protect against myocardial infarction, possibly by increasing levels of "good" (HDL) cholesterol.

This study examined the association between first-, second- and third-generation OCs and myocardial infarction.

Two hundred forty-eight women who had suffered myocardial infarction and 925 controls who had not were evaluated for birth-control use. The 18- to 49-year-old women provided information on OC use and other myocardial-infarction risk factors. Data were derived from the Risk of Arterial Thrombosis in Relation to Oral Contraceptives (RATIO) study in the Netherlands.

Results: Using any type of OC doubled heart-attack risk. In particular, first-generation OCs increased heart-attack risk by 2.7 times; second-generation OCs increased risk 2.5 times; and third-generation OCs increased risk 1.3 times, which the authors considered insignificant. Risks were highest among women who smoked, had diabetes mellitus, or had high levels of "bad" (LDL) cholesterol.

Conclusion: Although the data for third-generation OCs were inconclusive, it appears that they may provide a decreased risk for myocardial infarction, compared to first- and second-generation OCs. The authors stress, "Although the risk of myocardial infarction in users of oral contraceptives is small in absolute terms, it has an important effect on womens health, since 35 to 45 percent of women of reproductive age use oral contraceptives."

Note: The authors point out that the most important advice a doctor can give patients to decrease the risk of heart attack is to stop smoking. Additionally, OCs have also been linked to lower bone mineral density (See Oral Contraceptives Linked to Lower BMD in the February 2002 issue of CRR).

Tanis BC, van den Bosch M, Kemmeren JM, et al. Oral contraceptives and the risk of myocardial infarction. The New England Journal of Medicine 2001:345(25), pp. 1787-1793.

Chiropractic Research Review

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