Acute myocardial infarction and combined oral contraceptives: Results of an international multicentre case-control study

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dc.contributor.authorPoulter, N. R.
dc.contributor.authorChang, C. L.
dc.contributor.authorFarley, TMM
dc.contributor.authorKelaghan, J.
dc.contributor.authorMeirlk, O.
dc.contributor.authorMarmot, Michael Gideon
dc.contributor.authorDebert-Ribeiro, Myriam [UNIFESP]
dc.contributor.authorMedina, Ernesto
dc.contributor.authorArtigas, J.
dc.contributor.authorHe, Shen
dc.contributor.authorZhong, Yu Hui
dc.contributor.authorZhang, De Wei
dc.contributor.authorZhao, Wei Jin
dc.contributor.authorRojas, Oscar
dc.contributor.authorHeinemann, Lothar
dc.contributor.authorDonnan, Stuart
dc.contributor.authorHo, Suzanne
dc.contributor.authorBartfai, Gyorgy
dc.contributor.authorKisjanto, J.
dc.contributor.authorWilks, Rainford
dc.contributor.authorAgwanda, Reuben
dc.contributor.authorRuiz, Rossario
dc.contributor.authorKozuh-Novak, Mateja
dc.contributor.authorDusitsin, Nikorn
dc.contributor.authorVirutamasen, Pramuan
dc.contributor.authorPhanthumchinda, Kammant
dc.contributor.authorKoetsawang, Suporn
dc.contributor.authorPiya-Anant, Manee
dc.contributor.authorVessey, Martin P.
dc.contributor.authorDemirovic, Jasenka
dc.contributor.authorBelkic, Karen
dc.contributor.authorMwandila, W. S.
dc.contributor.authorMutale, C. M.
dc.contributor.authorMatenga, Jonathon
dc.contributor.authorWilson, Adrian
dc.contributor.authorVessey, M. P.
dc.contributor.authorPetitti, D.
dc.contributor.authorPerlman, J.
dc.contributor.authorHolck, S.
dc.contributor.authorLawley, S.
dc.contributor.authorSmith, S.
dc.contributor.authorShipley, M.
dc.contributor.authorOlsen, J.
dc.contributor.authorThorogood, M.
dc.contributor.institutionUniversidade Federal de São Paulo (UNIFESP)
dc.contributor.institutionUNIV CHILE
dc.contributor.institutionNATL RES INST FAMILY PLANNING
dc.contributor.institutionSICHUAN FAMILY PLANNING RES INST
dc.contributor.institutionSHANGHAI INST PLANNED PARENTHOOD RES
dc.contributor.institutionUNIV VALLE
dc.contributor.institutionZENTRUM EPIDEMIOL & GESUNDHEITSFORSCH
dc.contributor.institutionCHINESE UNIV HONG KONG
dc.contributor.institutionALBERT SZENT GYORGYI MED UNIV
dc.contributor.institutionUNIV INDONESIA
dc.contributor.institutionKENYA GOVT MED RES CTR
dc.contributor.institutionINTERUNIV MEXICANO INVEST EPIDEMIOL SALUD REPROD
dc.contributor.institutionUNIV W INDIES
dc.contributor.institutionESCUELA MED
dc.contributor.institutionUNIV LJUBLJANA
dc.contributor.institutionCHULALONGKORN HOSP
dc.contributor.institutionSIRIRAJ HOSP
dc.contributor.institutionUNIV OXFORD
dc.contributor.institutionUNIV BELGRADE
dc.contributor.institutionUNIV TEACHING HOSP
dc.contributor.institutionUNIV ZIMBABWE
dc.contributor.institutionKAISER PERMANENTE
dc.contributor.institutionNICHHD
dc.contributor.institutionAARHUS UNIV
dc.contributor.institutionLONDON SCH HYG & TROP MED
dc.date.accessioned2018-06-18T10:54:41Z
dc.date.available2018-06-18T10:54:41Z
dc.date.issued1997-04-26
dc.description.abstractBackground The association between oral contraceptive (OC) use and acute myocardial infarction (AMI) was established in studies from northern Europe and the USA, which took place during the 1960s and 1970s. Few data are available to quantify the risk worldwide of AMI associated with use of OCs introduced since those early studies. This hospital-based case-control study examined the association between a first AMI and current OC use in women from Africa, Asia, Europe, and Latin America (21 centres).Methods Cases were women aged 20-44 years who had definite or possible AMI (classified by history, electrocardiographic, and cardiac-enzyme criteria), who were admitted to hospital, and who survived for at least 24 h. Up to three hospital controls matched by 5-year age-band were recruited for each of the 368 cases (941 controls). All participants were interviewed while in hospital with the same questionnaire, which included information on medical and personal history, lifetime contraceptive use, and blood-pressure screening before the most recent episode of OC use. Odds ratios compared the risk of AMI in current OC users and in non-users (past users and never-users combined).Findings The overall odds ratio for AMI was 5.01 (95% CI 2.54-9.90) in Europe and 4.78 (2.52-9.07) in the non-European (developing) countries; however, these risk estimates reflect the frequent coexistence of other risk factors among OC users who have AMI. Very few AMIs were identified among women who had no cardiovascular risk factors and who reported that their blood pressure had been checked before OC use; odds ratios associated with OC use in such women were not increased in either Europe or the developing countries. Among OC users who smoked ten or more cigarettes per day, the odds ratios in Europe and in the developing countries were over 20. Similarly, among OC users with a history of hypertension (during pregnancy or at any other time), odds ratios were at least ten in both groups of countries, No consistent association between odds ratios for AMI and age of OC users or oestrogen dose was apparent in either group of countries, No significant increase in odds ratios was apparent with increasing duration of OC use among current users, and odds ratios were not significantly increased in women who had stopped using OCs, even after long exposure. The study had insufficient power to examine whether progestagen dose or type had any effect on AMI risk.Interpretation Current use of combined OCs is associated with an increased risk of AMI among women with known cardiovascular risk factors and among those who have not been effectively screened, particularly for blood pressure, AMI is extremely rare in younger (<35 years) non-smoking women who use OCs, and the estimated excess risk of AMI in such women in the European centres is about 3 per 10(6) woman-years. The risk is likely to be even lower if blood pressure is screened before, and presumably during, OC use. Only among older women who smoke is the degree of excess risk associated with OCs substantial (about 400 per 10(6) woman-years).en
dc.description.affiliationESCOLA PAULISTA MED,BR-04023 SAO PAULO,BRAZIL
dc.description.affiliationUNIV CHILE,ESCUELA SALUD PUBL,SANTIAGO,CHILE
dc.description.affiliationNATL RES INST FAMILY PLANNING,BEIJING,PEOPLES R CHINA
dc.description.affiliationSICHUAN FAMILY PLANNING RES INST,CHENGDU,PEOPLES R CHINA
dc.description.affiliationSHANGHAI INST PLANNED PARENTHOOD RES,SHANGHAI,PEOPLES R CHINA
dc.description.affiliationUNIV VALLE,FAC SALUD,CALI,COLOMBIA
dc.description.affiliationZENTRUM EPIDEMIOL & GESUNDHEITSFORSCH,BERLIN,GERMANY
dc.description.affiliationCHINESE UNIV HONG KONG,SHATIN 100083,HONG KONG
dc.description.affiliationALBERT SZENT GYORGYI MED UNIV,H-6701 SZEGED,HUNGARY
dc.description.affiliationUNIV INDONESIA,FAC MED,JAKARTA,INDONESIA
dc.description.affiliationKENYA GOVT MED RES CTR,NAIROBI,KENYA
dc.description.affiliationINTERUNIV MEXICANO INVEST EPIDEMIOL SALUD REPROD,DURANGO,MEXICO
dc.description.affiliationUNIV W INDIES,TROP METAB RES UNIT,KINGSTON 7,JAMAICA
dc.description.affiliationESCUELA MED,VALPARAISO,CHILE
dc.description.affiliationUNIV LJUBLJANA,INST PUBL HLTH,LJUBLJANA,SLOVENIA
dc.description.affiliationCHULALONGKORN HOSP,BANGKOK,THAILAND
dc.description.affiliationSIRIRAJ HOSP,BANGKOK,THAILAND
dc.description.affiliationUNIV OXFORD,OXFORD,ENGLAND
dc.description.affiliationUNIV BELGRADE,SCH MED,YU-11001 BELGRADE,YUGOSLAVIA
dc.description.affiliationUNIV TEACHING HOSP,LUSAKA,ZAMBIA
dc.description.affiliationUNIV ZIMBABWE,HARARE,ZIMBABWE
dc.description.affiliationUNIV OXFORD,OXFORD OX1 2JD,ENGLAND
dc.description.affiliationKAISER PERMANENTE,PASADENA,CA
dc.description.affiliationNICHHD,BETHESDA,MD
dc.description.affiliationAARHUS UNIV,DANISH EPIDMEIOL SCI CTR,DK-8000 AARHUS C,DENMARK
dc.description.affiliationLONDON SCH HYG & TROP MED,LONDON WC1,ENGLAND
dc.description.affiliationUnifespESCOLA PAULISTA MED,BR-04023 SAO PAULO,BRAZIL
dc.description.sourceWeb of Science
dc.format.extent1202-1209
dc.identifierhttp://dx.doi.org/10.1016/S0140-6736(97)02358-1
dc.identifier.citationLancet. London: Lancet Ltd, v. 349, n. 9060, p. 1202-1209, 1997.
dc.identifier.doi10.1016/S0140-6736(97)02358-1
dc.identifier.issn0140-6736
dc.identifier.urihttp://repositorio.unifesp.br/handle/11600/44827
dc.identifier.wosWOS:A1997WW71700009
dc.language.isoeng
dc.publisherLancet Ltd
dc.relation.ispartofLancet
dc.rightsinfo:eu-repo/semantics/restrictedAccess
dc.titleAcute myocardial infarction and combined oral contraceptives: Results of an international multicentre case-control studyen
dc.typeinfo:eu-repo/semantics/article
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