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Peer Reviewed

Title: Eligibility criteria in venous thromboembolism, myocardial infarction, and stroke among transdermal contraceptive system users.
Author: Dore DD; Norman H; Seeger JD
Source: Obstetrics and Gynecology. 2009 Jul;114(1):175.
Abstract: An erratum printed in Obstetrics & Gynecology in June of 2008 corrected the stated eligibility criterion in a study of venous thromboembolism, myocardial infarction (MI), and stroke in transdermal contraceptive users reported by Cole and colleagues. Originally, it was reported that the authors excluded women with malignancies other than nonmelanoma skin cancer. The actual exclusion implemented was slightly broader: women with a neoplasm other than benign skin disorders. We applied the originally stated exclusion of women to the original study population, so that women with evidence in the claims data of malignancy other than nonmelanoma skin cancer (International Classification of Diseases, 9th revision: 140.xx-208.xx, except 173.xx) were excluded rather than the broader version actually implemented (International Classification of Diseases, 9th revision: 140.xx-239.xx, except 232.xx). There were approximately 423,000 women in the source population before application of exclusions, and 2.4% of them were excluded because of the nonmalignancy neoplasm codes used. In the originally reported case-control analysis comparing use of the transdermal contraceptive to norgestimate- containing oral contraceptives with 35 micrograms of ethinyl estradiol, the odds ratio (OR) for venous thromboembolism was 2.0 (95% confidence interval [CI] 1.0-4.1) overall and 2.4 (95% CI 1.1-5.5) after exclusion of women with high-risk factors and 2.1 (95% CI 0.3-15.5) for MI. No strokes were observed among transdermal contraceptive users. Application of the narrower exclusion criterion (consistent with the originally stated exclusion by Cole and colleagues), yielded six additional cases matched to 24 controls, leading to ORs for venous thromboembolism of 2.0 (95% CI 1.0-4.0) overall and 2.5 (95% CI 1.1-5.5) after exclusion of women with high-risk factors and 2.1 (95% CI 0.3-15.5) for MI. No strokes were observed in transdermal contraceptive users. The broader definition of neoplasm that was used for exclusion in the original analysis did not materially affect the observed association measures. This finding is consistent with the study design principle that the application of broader exclusions will lead to noticeably different estimates than application of narrower exclusions only in settings where the effect (not just the risk) among excluded participants is substantially different from what it is among included participants. (full-text)
Language: English
Keywords:
UNITED STATES OF AMERICA | CRITIQUE | THROMBOEMBOLISM | MYOCARDIAL INFARCTION | CEREBROVASCULAR EFFECTS | CONTRACEPTIVE IMPLANTS | Developed Countries | North America | Americas | Embolism | Vascular Diseases | Diseases | Heart Diseases | Physiology | Biology | Contraceptive Methods | Contraception | Family Planning
Document Number: 341716

4.
Title: [Myocardial infarction and oral contraceptives] Infarctus du myocarde et contraceptifs oraux.
Author: Bounhoure JP; Galinier M; Roncalli J; Assoun B; Puel J
Source: Bulletin De L'Academie Nationale De Medecine. 2008 Mar;192(3):569-79; discussion 579.
Abstract: Shortly after the introduction of oral contraceptives in 1960, myocardial infarction (MI) started to emerge as a major adverse effect. Its mechanism and pathophysiology have remained elusive. Many epidemiological studies identified smoking, hypertension, diabetes and hypercholesterolemia as risk factors for coronary thrombosis in young women using oral contraceptives. The pathogenesis of MI involves two phases: atherosclerotic plaque formation, and thrombotic arterial occlusion. The use of very low doses of estrogen (less than 50 microg of ethinyl estradiol) and new progestagens have minimized the vascular risks. However, the risk remains in women who smoke or have other atherosclerotic risks factors. We report 12 cases of MI in women aged 35 +/- 5 years who were using different types of oral contraceptive. All the women had several risks factors, such as smoking, hypertension, hypercholesterolemia, obesity, and type II diabetes. Coronarography during the acute phase showed either occlusions on severe atherosclerotic stenoses or thrombosis of arteries with non significant atherosclerotic plaque. In two cases coronarography was normal after thrombolysis. Ten women recovered without sequelae, but reversible left ventricular dysfunction occurred in the other two women, who did not have acute-phase revascularization. Recent case-control studies show that the cardiovascular risk is very low with new, third-generation combined contraceptives. But the risk of MI increases with age, smoking, hypertension, dyslipidemia and diabetes. The absolute risks associated with oral contraceptives and smoking are higher in women over 35, because of the steeply rising incidence of atherosclerosis. It is mandatory to respect the classical contraindications of oral contraception.
Language: French
Keywords:
RESEARCH REPORT | CASE STUDIES | EPIDEMIOLOGY | WOMEN | MYOCARDIAL INFARCTION | ORAL CONTRACEPTIVES | TOBACCO USE | DIABETES | HYPERTENSION | VASCULAR DISEASES | ORAL CONTRACEPTIVES, CONTRAINDICATIONS | RISK FACTORS | Studies | Research Methodology | Public Health | Health | Demographic Factors | Population | Heart Diseases | Diseases | Contraceptive Methods | Contraception | Family Planning | Behavior | Contraceptive Safety | Safety | Biology
Document Number: 329006

Title: Tubercular myocarditis presenting with ventricular tachycardia.
Author: Khurana R; Shalhoub J; Verma A; Assomull R; Prasad SK; Kooner JS; Sethi A
Source: Nature Clinical Practice. Cardiovascular Medicine. 2008 Mar;5(3):169-74.
Abstract: BACKGROUND: A previously fit and healthy 30-year-old man reported experiencing palpitations accompanied by nausea, sweating and presyncope. These symptoms were found to be associated with episodes of nonsustained ventricular tachycardia. He was a nonsmoker, did not drink excessively, denied illicit drug use and had no family history of structural cardiac disease or sudden death. INVESTIGATIONS: Electrocardiography, laboratory tests, electrophysiological studies, echocardiography, coronary angiography, chest radiography, cardiac MRI (with late gadolinium enhancement), chest CT, lymph-node biopsy, Ziehl Nielsen staining, blood and sputum cultures and heaf testing. DIAGNOSIS: Tubercular myocarditis. MANAGEMENT: Antituberculous chemotherapy supported by antiarrhythmic and steroid pharmacotherapy and cardioverter-defibrillator implantation. Repeated imaging was performed to monitor disease progression.
Language: English
Keywords:
UNITED KINGDOM | RESEARCH REPORT | MEN | SIGNS AND SYMPTOMS | CARDIOVASCULAR EFFECTS | EXAMINATIONS AND DIAGNOSES | TUBERCULOSIS | MYOCARDIAL INFARCTION | DRUGS | ADMINISTRATION AND DOSAGE | MANAGEMENT | Developed Countries | Europe, Western | Europe | Demographic Factors | Population | Diseases | Physiology | Biology | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Infections | Heart Diseases | Treatment | Organization and Administration
Document Number: 325744

Title: Serological evidence of chronic Chlamydia pneumoniae infection in coronary artery disease.
Author: Agarwal A; Chander Y; Nagendra A
Source: Medical Journal Armed Forces India. 2007 Jul;63(3):229-232.
Abstract: Recent studies have suggested that Chlamydia pneumoniae infection could be involved in atherosclerosis and related clinical manifestations such as coronary artery disease, carotid artery stenosis and myocardial infarction. Serum IgG, IgM and IgA antibodies to chlamydia genus specific antigen were measured by enzyme linked immunosorbent assay (ELISA) in 100 cases of angiographically demonstrated coronary artery disease (CAD) and 100 randomly selected healthy individuals as controls after matching for age and sex. All the samples positive for chlamydia genus specific IgG antibodies were then subjected to Chlamydia pneumoniae species specific IgG antibody ELISA. Seroprevalence of chlamydia genus specific IgG antibodies in control group was 59% with an increase in seropositivity with increasing age. The overall seroprevalence of IgG antibodies was 76% in CAD group and the prevalence was significantly high in all age groups as compared to controls. The odds ratio was 2.20 for seropositivity of chlamydia genus specific IgG antibodies in patients with myocardial infarction (MI) and/or angina than in control group. No significant association was observed for IgA and IgM anti-chlamydial antibodies. The odds ratio for prevalence of Chlamydia pneumoniae species specific IgG antibodies in CAD patients increased to 2.55 in comparison to age and sex matched controls. Current study supports the reported association between C pneumoniae infection and CAD in Indian population. (author's)
Language: English
Keywords:
INDIA | RESEARCH REPORT | CONTROL GROUPS | CLIENTS | BACTERIAL AND FUNGAL DISEASES | ARTERIAL OCCLUSIVE DISEASES | ATHEROSCLEROSIS | MYOCARDIAL INFARCTION | ANTIBODIES | PREVALENCE | LABORATORY PROCEDURES | Developing Countries | Asia, Southern | Asia | Research Methodology | Program Activities | Programs | Organization and Administration | Infections | Diseases | Vascular Diseases | Arteriosclerosis | Heart Diseases | Immunologic Factors | Immunity | Immune System | Physiology | Biology | Measurement | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 319179

7.
Title: Triggers of nonfatal myocardial infarction in Costa Rica: heavy physical exertion, sexual activity, and infection.
Author: Baylin A; Hernandez-Diaz S; Siles X; Kabagambe EK; Campos H
Source: Annals of Epidemiology. 2007 Feb;17(2):112-118.
Abstract: There are no data for factors that could trigger myocardial infarction (MI) in the context of lifestyles in developing countries. Using a case-crossover design, we assessed the effect of heavy physical exertion, sexual activity, acute respiratory tract infections, and gastroenteritis as triggers for MI in 530 survivors of a first MI from Costa Rica. Relative risks (RRs) for MI in the hour after heavy physical exertion and 2 hours after sexual activity were 4.94 (95% confidence interval [CI], 3.73-6.54) and 5.47 (95% CI, 2.71-11.02). Risk for MI after heavy physical exertion was greater for patients with poor physical fitness or elevated underlying cardiovascular risk (p < 0.0001 and p = 0.06, tests of homogeneity). RRs for acute respiratory tract infection and gastroenteritis were 1.48 (95% CI, 0.92-2.38) and 1.27 (95% CI, 0.95-1.69), respectively. Patients with three or more risk factors had an RR for MI for gastroenteritis of 2.08 (95% CI, 1.31-3.28). Our results confirm previous studies in developed countries showing that heavy physical exertion and sexual activity are potential triggers for MI, and their effect is modified by physical fitness and underlying cardiovascular risk. Additional studies that explore the biologic effects of gastroenteritis as triggers of MI are warranted. (author's)
Language: English
Keywords:
COSTA RICA | RESEARCH REPORT | STATISTICAL STUDIES | CLIENTS | MYOCARDIAL INFARCTION | FITNESS | GASTROINTESTINAL EFFECTS | RESPIRATORY INFECTIONS | SEXUAL INTERCOURSE | Central America | Latin America | Americas | Developing Countries | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Heart Diseases | Diseases | Health | Physiology | Biology | Infections | Reproduction
Document Number: 311551

8.
Peer Reviewed

Title: Venous thromboembolism, myocardial infarction, and stroke among transdermal contraceptive system users.
Author: Cole JA; Norman H; Doherty M; Walker AM
Source: Obstetrics and Gynecology. 2007 Feb 1;109(2):339-346.
Abstract: The objective was to estimate the incidence of venous thromboembolism, acute myocardial infarction, and ischemic stroke among transdermal contraceptive system users compared with users of norgestimate-containing oral contraceptives with 35 mcg ethinyl estradiol. We began with insurance claims data from UnitedHealthcare. We identified women exposed to the transdermal contraceptive system or norgestimate-containing oral contraceptives from April 2002 through December 2004. Outcomes were confirmed from medical records. We calculated incidence rates and age-adjusted incidence rate ratios. In a nested case-control analysis, we investigated and controlled for confounding. There were 49,048 woman-years of transdermal contraceptive system exposure and 202,344 woman-years of norgestimate-containing oral contraceptives exposure. There was a more than two-fold increase in the venous thromboembolism rate (incidence rate ratio 2.2, 95% confidence interval [CI] 1.3-3.8) among transdermal contraceptive system users (20 cases, 40.8 per 100,000 woman-years) compared with norgestimate-containing oral contraceptives users (37 cases, 18.3 per 100,000 woman-years). Acute myocardial infarction occurred in three transdermal contraceptive system users compared with seven among norgestimate-containing oral contraceptives users (incidence rate ratio 1.8, 95% CI 0.5- 6.8). No strokes occurred among transdermal contraceptive system users, whereas 10 occurred among norgestimate-containing oral contraceptives users. In the nested case-control analysis, after exclusions for high-risk factors, the odds ratio for venous thromboembolism was 2.4 (95% CI 1.1-5.5). There was a more than two-fold increase in the risk of venous thromboembolism associated with use of the transdermal contraceptive system. Acute myocardial infarction and stroke occurred too rarely to ascertain precise risk estimates. (author's)
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | COMPARATIVE STUDIES | WOMEN | THROMBOEMBOLISM | MYOCARDIAL INFARCTION | CEREBROVASCULAR EFFECTS | INCIDENCE | ORAL CONTRACEPTIVES | NORGESTIMATE | ETHINYL ESTRADIOL | HEALTH INSURANCE | ORAL CONTRACEPTIVES, SIDE EFFECTS | CONTRACEPTIVE AGENTS, SIDE EFFECTS | North America | Americas | Developed Countries | Research Methodology | Studies | Demographic Factors | Population | Embolism | Vascular Diseases | Diseases | Heart Diseases | Physiology | Biology | Measurement | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraceptive Agents, Estrogen | Financial Activities | Economic Factors | Contraceptive Safety | Safety | Public Health | Health
Document Number: 312126

Peer Reviewed

Title: A prospective study of oral contraceptive use and risk of myocardial infarction among Swedish women.
Author: Margolis KL; Adami HO; Luo J; Ye W; Weiderpass E
Source: Fertility and Sterility. 2007 Aug;88(2):310-316.
Abstract: The objective was to determine the risk for incident myocardial infarction (MI) in women exposed to modern formulations of oral contraceptives (OCs). The design was a population-based, prospective cohort study begun in 1991 with follow-up through 2002 for an average of 11 years. A total of 48,321 Swedish women aged 30-49 were randomly selected from the population residing in the Uppsala Health Care Region of Sweden in 1990-91. Fatal and nonfatal MI ascertained through linkages with nationwide health registries for death, hospitalization, and emigration. There were 214 incident cases of MI. Compared with never users, neither former (relative risk, 1.0; 95% confidence interval, 0.7-1.4) nor current (relative risk, 0.7; 95% confidence interval, 0.4-1.4) OC users at study enrollment had an elevated risk of future MI in models adjusted for coronary heart disease risk factors. Risk of MI was not elevated by prolonged use or in subgroups defined by characteristics of the women or types of OC. Use of OC was not associated with an increased risk of MI in this prospective study, in which most current users of OC were taking low-dose estrogen and second- or third-generation progestins. (author's)
Language: English
Keywords:
SWEDEN | RESEARCH REPORT | PROSPECTIVE STUDIES | INCIDENCE | WOMEN | MYOCARDIAL INFARCTION | HEART DISEASES | EXPOSURE | ORAL CONTRACEPTIVES | Europe, Northern | Europe | Developed Countries | Studies | Research Methodology | Measurement | Demographic Factors | Population | Diseases | Risk Factors | Biology | Contraceptive Methods | Contraception | Family Planning
Document Number: 319373

10.

Title: Acute myocardial infarction associated with Yasmin oral contraceptive [letter]
Author: Orti G; Mira Y; Vaya A
Source: Clinical and Applied Thrombosis / Hemostasis. 2007 Jul;13(3):336-337.
Abstract: The new third-generation contraceptive Yasmin (30 �g ethinylestradiol and 3 mg of drospirenone; Bayer Schering Pharma, Kenilworth, NJ) has been available on the market in all of the European Union countries since the year 2000. This contraceptive has certain characteristics that differentiate it from others because it has a lower estrogen component in its composition compared with previous oral contraceptives. It has also been suggested that it has a lower risk of thrombosis than other oral contraceptives. This is because interim results from Schering's postmarketing surveillance study of 1 million cycles showed that after 1 year, 1 episode of venous thrombosis occurred among Yasmin users compared with 5 episodes among users of other oral contraceptives This opinion is not shared by other authors, however, who state that despite this difference at the chemical level, there is no difference in thrombosis risk , with the risk being very similar: 60 per 100 000 cases of deep vein thrombosis a year inwomen who take Yasmin compared with 60 to 73 per 100 000 cases a year in women who take other older contraceptive pills. Although different cases of thromboembolism have been reported in patients taking Yasmin, no report has been published about Yasmin and myocardial infarction. (excerpt)
Language: English
Keywords:
SPAIN | CRITIQUE | CASE HISTORIES | MYOCARDIAL INFARCTION | RISK FACTORS | ORAL CONTRACEPTIVES, SIDE EFFECTS | THROMBOSIS | TOBACCO USE | Europe, Southwestern | Europe | Developed Countries | Data Collection | Research Methodology | Heart Diseases | Diseases | Biology | Contraceptive Safety | Safety | Public Health | Health | Thromboembolism | Embolism | Vascular Diseases | Behavior
Document Number: 322243

11.

Title: TB-related sudden death (TBRSD) due to myocarditis complicating miliary TB: a case report and review of the literature.
Author: Biedrzycki OJ; Baithun SI
Source: American Journal of Forensic Medicine and Pathology. 2006 Dec;27(4):335-336.
Abstract: TB-related sudden death (TBRSD) is rarely reported in the literature and in the majority of cases is due to bronchopneumonia and hemoptysis. Cardiac complications of tuberculosis causing sudden death can take many forms and are rarer still, with only a handful of cases reported. We describe a case of a previously fit and healthy 20-year-old Asian female who, after returning from a holiday in India, collapsed while getting off a bus. At postmortem, the only macroscopic finding of note was a localized area of fibrosis on the anterior wall of the left ventricle. Microscopic examination of this area showed Langhans giant cells; noncaseating epithelioid granulomas and acid-fast bacilli were demonstrated on Ziehl Nielsen staining. In addition, the lungs, liver, and kidneys contained multiple noncaseating granulomas. The case serves to highlight the protean nature in the presentation of this disease and the importance of postmortem histology in autopsy work. (author's)
Language: English
Keywords:
INDIA | LITERATURE REVIEW | CLIENTS | CAUSES OF DEATH | TUBERCULOSIS | PNEUMONIA | PULMONARY EFFECTS | MYOCARDIAL INFARCTION | Asia, Southern | Asia | Developing Countries | Program Activities | Programs | Organization and Administration | Mortality | Population Dynamics | Demographic Factors | Population | Infections | Diseases | Physiology | Biology | Heart Diseases
Document Number: 314504

12.
Peer Reviewed

Title: Combined oral contraceptive use among women with hypertension: a systematic review.
Author: Curtis KM; Mohllajee AP; Martins SL; Peterson HB
Source: Contraception. 2006 Feb;73(2):179-188.
Abstract: Women with hypertension are at increased risk for cardiovascular events. Combined oral contraceptive (COC) use, even among low-dose users, has been associated with a small excess risk for cardiovascular events among healthy women. In this systematic review, we examined cardiovascular risks among COC users with hypertension. After searching MEDLINE for all articles published from 1966 through February 2005 relevant to COC use, hypertension and cardiovascular disease, we identified 25 articles for this review. Overall, these studies showed that hypertensive COC users were at higher risk for stroke and acute myocardial infarction (AMI) than hypertensive non-COC users, but that they were not at higher risk for venous thromboembolism (VTE). Women who did not have their blood pressure measured before initiating COC use were at higher risk for ischemic stroke and AMI, but not for hemorrhagic stroke or VTE, than COC users who did not have their blood pressure measured. (author's)
Language: English
Keywords:
UNITED STATES OF AMERICA | NORTH CAROLINA | RESEARCH REPORT | DATA ANALYSIS | STUDIES | WHO | WOMEN | ORAL CONTRACEPTIVES, COMBINED | HYPERTENSION | THROMBOEMBOLISM | CEREBROVASCULAR EFFECTS | MYOCARDIAL INFARCTION | ORAL CONTRACEPTIVES, CONTRAINDICATIONS | CONTRACEPTIVE SAFETY | Developed Countries | North America | Americas | Research Methodology | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors | Demographic Factors | Population | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Vascular Diseases | Diseases | Embolism | Physiology | Biology | Heart Diseases | Safety | Public Health | Health
Document Number: 296205

13.
Peer Reviewed

Title: Past oral contraceptive use and angiographic coronary artery disease in postmenopausal women: data from the National Heart, Lung, and Blood Institute - sponsored Women's Ischemia Syndrome evaluaton.
Author: Merz CN; Johnson BD; Berga S; Braunstein G; Reis SE
Source: Fertility and Sterility. 2006 May;85(5):1425-1431.
Abstract: The objective was to evaluate past oral contraceptive use and angiographic coronary artery disease in women. Setting: Academic medical centers. Patient(s): Six hundred seventy-two postmenopausal women enrolled in the Women's Ischemia Syndrome Evaluation (WISE) with coronary risk factors undergoing coronary angiography for suspected myocardial ischemia. Intervention(s): Past oral contraceptive use, assessed by reproductive questionnaire. Main Outcome Measure(s): Quantitative coronary artery disease, assessed by a core angiography laboratory. Past oral contraceptive use was associated with a lower mean coronary artery disease severity index score (mean � SD: 11.8 � 10.3 vs. 18.7 � 17.3) compared with non-prior users, despite age adjustment. Past oral contraceptive use remained a significant independent negative predictor of coronary artery disease severity when adjusting for coronary risk factors, including age, diabetes mellitus, triglycerides, low-density lipoprotein cholesterol, smoking, aspirin use, and lipid-lowering medication (model R/2 = 0.19). The modeling indicated that past oral contraceptive use was associated with a 2.44 lower coronary artery disease severity score index. There was no apparent relationship between duration of past oral contraceptive use and the coronary artery disease severity index score. Past oral contraceptive use is associated with less coronary artery disease, measured by quantitative coronary angiography, among postmenopausal women with suspected myocardial ischemia. These findings suggest that a prospective study should address the hypothesis that past oral contraceptive use during the premenopausal years might offer women protection from atherosclerotic coronary disease later in life. (author's)
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | CLINICAL RESEARCH | EPIDEMIOLOGIC METHODS | WOMEN | ORAL CONTRACEPTIVES, SIDE EFFECTS | MENOPAUSE | CARDIOVASCULAR EFFECTS | HEART DISEASES | MYOCARDIAL INFARCTION | North America | Americas | Developed Countries | Research Methodology | Demographic Factors | Population | Contraceptive Safety | Safety | Public Health | Health | Reproduction | Physiology | Biology | Diseases
Document Number: 299908

14.
Peer Reviewed

Title: Association between the current use of low-dose oral contraceptives and cardiovascular arterial disease: a meta-analysis.
Author: Baillargeon JP; McClish DK; Essah PA; Nestler JE
Source: Journal of Clinical Endocrinology and Metabolism. 2005 Jul;90(7):3863-3870.
Abstract: The long-term cardiovascular safety of widely used oral contraceptives (OCs) is still debated, and no meta-analysis assesses the modern use of OCs and the associated cardiovascular risks. We aimed to assess the risk of cardiovascular diseases associated with current use of low-dose combined OCs. All studies published between January 1980 and October 2002 were searched using MEDLINE, BIOSIS, and Scientific Citations. Original studies were selected independently by two investigators (J.P.B., P.A.E.) based on inclusion criteria: low-dose combined OC (< 50 �g of ethinyl-estradiol); more than 10 cases in low-dose users; clear definition of cases; concurrent controls; and control for age. A third investigator (J.E.N.) adjudicated disagreements. From 2715 identified articles, 14 independent studies were included. All data were abstracted by one investigator (J.P.B.) in a systematic manner. Classification of OCs and types of exposure were directly abstracted from studies. Current use was defined as use at the time of the event or within 3 months. Only peer-reviewed studies with definition of events as definite or possible, based on prespecified criteria, were included. The summary risk estimates associated with current use of low-dose OCs were 1.84 [95% confidence interval (CI) = 1.38, 2.44] for myocardial infarctions and 2.12 (95% CI =1.56, 2.86) for ischemic strokes. The overall summary odds ratio for both outcomes was 2.01 (95% CI =1.63, 2.48). Second generation OCs were associated with a significant increased risk of both myocardial infarction and ischemic stroke events [1.85 (95% CI =1.03, 3.32) and 2.54 (95% CI_1.96, 3.28), respectively]; and third-generation OCs, for ischemic stroke outcome only [2.03 (95% CI =1.15, 3.57)]. In conclusion, a rigorous meta-analysis of the literature suggests that current use of low-dose OCs significantly increases the risk of both cardiac and vascular arterial events, including a significant risk of vascular arterial complications with third generation OCs. (author's)
Language: English
Keywords:
UNITED STATES OF AMERICA | CANADA | LITERATURE REVIEW | WOMEN | FAMILY PLANNING ACCEPTORS | ORAL CONTRACEPTIVES, LOW-DOSE | ORAL CONTRACEPTIVES, SIDE EFFECTS | CARDIOVASCULAR EFFECTS | CEREBROVASCULAR EFFECTS | MYOCARDIAL INFARCTION | North America | Americas | Developed Countries | North America, Northern | Demographic Factors | Population | Family Planning Programs | Family Planning | Oral Contraceptives | Contraceptive Methods | Contraception | Contraceptive Safety | Safety | Public Health | Health | Physiology | Biology | Heart Diseases | Diseases
Document Number: 289651

15.
Peer Reviewed

Title: Potential impact of oral contraceptive choice on myocardial infarction mortality and deep vein thrombosis.
Author: Martin K; Moride Y; Metge C; Moore N; B�gaud B
Source: Journal of Family Planning and Reproductive Health Care. 2005;31(1):37-39.
Abstract: The objectives were to summarise the epidemiological evidence on the relationship between second- (OC2) and third generation (OC3) oral contraceptives (OC) and the mortality associated with deep vein thrombosis (DVT) and myocardial infarction (MI), and to extrapolate and balance the evidence for these risks to the population of French OC users. All studies published on the risk of MI during OC2 and OC3 use were analysed. For DVT the Committee for Proprietary Medicinal Products public assessment report published in 2001 and more recent studies published on this topic were used. The estimates of odds ratios (OR) for risk of death from DVT or MI were extracted from the published manuscripts. ORs were used to calculate the aetiological fraction of risk for death from DVT and MI in the population; the relative impact of OC3 compared to OC2 use was expressed as an excess risk of death overall and by age group for French women. Compared with OC2, the use of OC3 would prevent a maximum of 24 deaths from MI per year and induce a maximum of 16 deaths. Conversely, OC3 would induce 282�940 excess cases of DVT per year, resulting in 28�94 pulmonary embolisms and 3�19 deaths in the 4.7 million French OC users. Balancing the evidence, it is difficult to conclude that the overall cardiovascular risk is significantly lower for either of the two OC schemes. (author's)
Language: English
Keywords:
FRANCE | CANADA | LITERATURE REVIEW | WOMEN | FAMILY PLANNING ACCEPTORS | MYOCARDIAL INFARCTION | MORTALITY DETERMINANTS | THROMBOSIS | CONTRACEPTIVE METHODS CHOSEN | ORAL CONTRACEPTIVES, SIDE EFFECTS | CONTRACEPTION RESEARCH | ORAL CONTRACEPTIVES, LOW-DOSE | Europe, Western | Europe | Developed Countries | North America, Northern | Americas | Demographic Factors | Population | Family Planning Programs | Family Planning | Heart Diseases | Diseases | Mortality | Population Dynamics | Thromboembolism | Embolism | Vascular Diseases | Contraceptive Usage | Contraception | Contraceptive Safety | Safety | Public Health | Health | Oral Contraceptives | Contraceptive Methods
Document Number: 281561

16.
Peer Reviewed

Title: Post-infarction ventricular septal defect in Nairobi: case report.
Author: Yonga GO; Munene JC; Ogendo SW
Source: East African Medical Journal. 2005 Dec;82(12):660-662.
Abstract: Post infarction ventricular septal defect results from perforation of the ventricular septum secondary to ischaemic injury following myocardial infarction. Ischaemic heart disease till recently was thought to be an uncommon disease in this part of the world, but now more and more cases are being seen as a result of the changes in the life styles of the population in this country and in the developing world in general. This is a case report of the first case of post infarction ventricular septal defect presenting to surgery for repair in this country. (author's)
Language: English
Keywords:
KENYA | RESEARCH REPORT | CLIENTS | MYOCARDIAL INFARCTION | SURGERY | TREATMENT | LIFE STYLE | DIET | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Program Activities | Programs | Organization and Administration | Heart Diseases | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Behavior | Nutrition
Document Number: 301974

17.
Title: Combined oral contraceptives and the risk of myocardial infarction.
Author: Keeling D
Source: Annals of Medicine. 2003;35:413-418.
Abstract: The studies on he combined oral contraceptive (COC) pill and myocardial infarction are reviewed. A reasonable conclusion is that the COC pill causes a two-fold increase in the risk of myocardial infarction. There is a marked interaction with smoking. The pill causes coagulation changes and affects lipoprotein and carbohydrate metabolism and these changes provide a plausible explanation for its effect. However, there are dangers in using these surrogate end-points to predict which pills carry the greatest risk. This must depend on an assessment of the epidemiology, and at present third generation pills have not convincingly been shown to be safer in this regard. The risk of causing myocardial infarction in non-smokers is small but we should be wary of prescribing the pill to smokers over 34 years old and especially to smokers over 39 years old. (author's)
Language: English
Keywords:
UNITED KINGDOM | LITERATURE REVIEW | EPIDEMIOLOGIC METHODS | WOMEN | ORAL CONTRACEPTIVES, COMBINED | MYOCARDIAL INFARCTION | RISK ASSESSMENT | TOBACCO USE | LIPID METABOLIC EFFECTS | SERUM PROTEIN EFFECTS | CARBOHYDRATE METABOLIC EFFECTS | BLOOD COAGULATION EFFECTS | INCIDENCE | RISK FACTORS | Developed Countries | Europe, Western | Europe | Research Methodology | Demographic Factors | Population | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Heart Diseases | Diseases | Evaluation | Behavior | Lipids | Physiology | Biology | Hematological Effects | Hemic System | Metabolic Effects | Measurement
Document Number: 188498

19.
Title: Risk of ischemic stroke among users of the oral contraceptive pill. The Melbourne Risk Factor Study (MERFS) Group.
Author: Siritho S; Thrift AG; McNeil JJ; You RX; Davis SM
Source: Stroke. 2003;34:1575-1580.
Abstract: Background and Purpose�Use of oral contraceptives has increased, and there is uncertainty about the stroke risk associated with their use. Our aim was to investigate this issue. Methods�Using case-control techniques, we identified consecutive women with ischemic stroke from 4 Melbourne hospitals. All patients were between 15 and 55 years of age and had no prior stroke. Neighborhood-based control subjects were individually age-matched (65 years) and geographically matched to subject cases. A questionnaire administered to participants elicited information about prior exposure to various potential risk factors, including the oral contraceptive pill (OCP). Results�We included 234 cases and 234 controls (mean age, 42 years). Compared with noncurrent use, current use of the OCP, in doses of #50 mg estrogen, was not associated with an increased risk of ischemic stroke (odds ratio [OR] 1.76; 95% CI, 0.86 to 3.61; P50.124). Factors associated with an increased risk of ischemic stroke were a history of hypertension (OR, 2.18; 95% CI, 1.22 to 3.91), transient ischemic attack (OR, 8.17; 95% CI, 1.69 to 39.6), previous myocardial infarction (OR, 5.64; 95% CI, 1.04 to 30.61), and diabetes mellitus (OR, 5.42; 95% CI, 1.42 to 20.75); family history of stroke (OR, 2.22; 95% CI, 1.12 to 4.43); and smoking .20 cigarettes per day (OR, 3.68; 95% CI, 1.22 to 11.09). Conclusions�There was no evidence for an association between ischemic stroke and use of the OCP in low doses (#50 mg estrogen) in young Australian women. Other modifiable risk factors such as hypertension, diabetes mellitus, and smoking are important. (author's)
Language: English
Keywords:
AUSTRALIA | RESEARCH REPORT | CASE CONTROL STUDIES | QUESTIONNAIRES | ADOLESCENTS, FEMALE | ADULTS | WOMEN | ORAL CONTRACEPTIVES | ESTROGENS | HYPERTENSION | MYOCARDIAL INFARCTION | NEUROLOGIC EFFECTS | RISK FACTORS | ADMINISTRATION AND DOSAGE | Developed Countries | Oceania | Studies | Research Methodology | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Contraceptive Methods | Contraception | Family Planning | Hormones | Endocrine System | Physiology | Biology | Vascular Diseases | Diseases | Heart Diseases | Drugs | Treatment
Document Number: 181347

20.
Peer Reviewed

Title: Research eyes MI risk in oral contraceptive use.
Source: Contraceptive Technology Update. 2002 Mar;23(3):29-31.
Abstract: New European research examines the association between oral contraceptive (OC) use and the risk of myocardial infarction (MI). The research looks at the OC-MI risk association according to the OC�s type of progestin, estrogen dose, and the presence or absence of prothrombotic mutations in the women who used them. One population-based, case-control study enrolled 248 women ages 18 to 49 in the Netherlands who had had a first MI between 1990 and 1995, as well as 925 women who had not had a MI and were matched for age, calendar year of the index event and area of residence. This research followed findings of other European studies that indicate no benefit of lower estrogen doses on the risk of deep- vein thrombosis and pulmonary embolism, and an excess risk with third- generation, higher dose, progestins over second-generation progestins. The main findings of the Netherlands study were that MI risk is not lower with lower estrogen dose. Results were inconclusive for second generation pills, which had levonorgestrel, and for third generation pills, which had desogestrel or gestodene. The consensus among several doctors in the US in reaction to these and similar findings is that the risk of MI due to cigarette smoking is substantially higher than the risk from any generation of progestin. It is noted that women should be counseled to discontinue cigarette smoking, a chief factor in MI risk.
Language: English
Keywords:
NETHERLANDS | UNITED STATES OF AMERICA | SUMMARY REPORT | CASE CONTROL STUDIES | ORAL CONTRACEPTIVES | CONTRACEPTIVE USAGE | CONTRACEPTIVE AGENTS, PROGESTIN | MYOCARDIAL INFARCTION | RISK FACTORS | TOBACCO USE | Europe, Western | Europe | Developed Countries | North America | Americas | Studies | Research Methodology | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Female | Contraceptive Agents | Heart Diseases | Diseases | Biology | Behavior
Document Number: 164512

21.

Peer Reviewed

Title: Use of any combined pill type confers an elevated risk of a first heart attack.
Author: Lane T
Source: International Family Planning Perspectives. 2002 Jun;28(2):127-8.
Abstract: In Netherlands, a population-based case control study was conducted to compare the effects on the risk of myocardial infarction. A standardized questionnaire was sent to women aged 18-49 who were using second- or third-generation pills and who had been hospitalized for a first myocardial infarction between January 1990 and October 1995. A randomly selected group of women with similar pill use who had not had a myocardial infarction comprised the control group. Overall, the study showed that the use of any oral contraceptive significantly raises the likelihood of a first myocardial infarction. The results of the study suggest, although inconclusively, that women who use third-generation pills are less likely to have a heart attack than those using pills containing the second- generation drug levonorgestrel. The researchers noted that the absolute risk of heart attack among pill users is small, but because all combined oral contraceptives (OCs) are equally effective means of birth control, the issue of safety is paramount. Hence, in prescribing OCs, clinicians should screen women for conventional risk factors for cardiovascular events.
Language: English
Keywords:
NETHERLANDS | RESEARCH REPORT | ADULTS | WOMEN | STATISTICAL REGRESSION | ORAL CONTRACEPTIVES | MYOCARDIAL INFARCTION | RISK FACTORS | Europe, Western | Europe | Developed Countries | Age Factors | Population Characteristics | Demographic Factors | Population | Data Analysis | Research Methodology | Contraceptive Methods | Contraception | Family Planning | Heart Diseases | Diseases | Biology
Document Number: 168555

22.

23.
Title: Female hormones and thrombosis.
Author: Rosendaal FR; Helmerhorst FM; Vandenbroucke JP
Source: Arteriosclerosis, Thrombosis, and Vascular Biology. 2002 Feb;22(2):201-210.
Abstract: Exogenous hormones are used by more than a hundred million women worldwide as oral contraceptives or for postmenopausal hormone replacement. Oral contraceptives increase the risk of venous thrombosis, of myocardial infarction, and of stroke. The risk is highest during the first year of use. The venous thrombotic risk of oral contraceptives is high among women with coagulation abnormalities and with so-called third-generation contraceptives (containing desogestrel or gestodene). The risk of myocardial infarction does not appear to depend on coagulation abnormalities or the type of oral contraceptive. Hormone replacement therapy increases the risk of venous thrombosis. This risk is also highest in the first year of use and among women with coagulation abnormalities. The risk becomes very high in women with a previous venous thrombosis. Randomized trials have not confirmed a beneficial effect of postmenopausal hormones on the occurrence of myocardial infarction. (author's)
Language: English
Keywords:
LITERATURE REVIEW | STUDIES | HORMONE REPLACEMENT THERAPY | ORAL CONTRACEPTIVES, SIDE EFFECTS | MYOCARDIAL INFARCTION | WOMEN | CEREBROVASCULAR EFFECTS | THROMBOSIS | VASCULAR DISEASES | RISK FACTORS | SIDE EFFECTS | CONTRACEPTIVE METHODS | Research Methodology | Treatment | Contraceptive Safety | Safety | Public Health | Health | Heart Diseases | Diseases | Demographic Factors | Population | Physiology | Biology | Thromboembolism | Embolism | Contraception | Family Planning
Document Number: 176170

24.
Peer Reviewed

Title: Menstrual cycle irregularity and risk for future cardiovascular disease.
Author: Solomon CG; Hu FB; Dunaif A; Rich-Edwards JE; Stampfer MJ
Source: Journal of Clinical Endocrinology and Metabolism. 2002 May;87(5):2013-2017.
Abstract: Cross-sectional studies suggest that women who have irregular menstrual cycles and hyperandrogenism may be at increased risk for cardiovascular disease (CVD). However, prospective data are lacking on the relationship between menstrual cycle irregularity and subsequent CVD risk. The objective of this study was to assess prospectively the risk for coronary heart disease (CHD) and stroke associated with a history of irregular menstrual cycles. The study design was a prospective cohort study of 82,439 female nurses who provided information in 1982 on prior menstrual regularity (at ages 20-35 yr) and were followed through 1996 for cardiovascular events. Incident reports of nonfatal myocardial infarction, fatal CHD, and nonfatal and fatal stroke were made. Medical records were reviewed for confirmation. During 14 yr (1,155,915 person-yr) of follow-up, there were 1417 incident cases of CHD and 838 incident cases of stroke, including 471 cases of ischemic stroke. Compared with women reporting a history of very regular menstrual cycles, women reporting usually irregular or very irregular cycles had an increased risk for nonfatal or fatal CHD [age-adjusted relative risks (RR), 1.25 and 1.67, respectively; 95% confidence intervals (CI), 1.07-1.47 and 1.35-2.06, respectively]. Increased risks for CHD associated with prior cycle irregularity remained significant after adjustment for body mass index and several potential confounders. There was a nonsignificant increase in overall stroke risk (RR, 1.30; 95% CI = 0.97-1.74) and in ischemic stroke risk (RR, 1.40; 95% CI = 0.97-2.04) associated with very irregular cycles. Menstrual cycle irregularity may be a marker of metabolic abnormalities predisposing to increased risk for CVD. (author's)
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | PROSPECTIVE STUDIES | COHORT ANALYSIS | WOMEN | MENSTRUAL CYCLE | MENSTRUATION DISORDERS | RISK FACTORS | CARDIOVASCULAR EFFECTS | CEREBROVASCULAR EFFECTS | MYOCARDIAL INFARCTION | North America | Americas | Developed Countries | Studies | Research Methodology | Demographic Factors | Population | Menstruation | Reproduction | Diseases | Biology | Physiology | Heart Diseases
Document Number: 295236

26.
Title: Oral contraceptives and myocardial infarction -- the search for the smoking gun [editorial]
Author: Chasan-Taber L; Stampfer M
Source: New England Journal of Medicine. 2001 Dec 20;345(25):1841-2.
Abstract: Use of oral contraceptives (OCs) became widespread some 40 years ago, and, according to the writer of this editorial, reports of an excess risk of cardiovascular disease among women using these agents soon followed. Despite new formulations with a lower hormone content, use of OCs still carried an increased risk of myocardial infarction, mainly attributable to a striking synergistic interaction with cigarette smoking. In this issue of the New England Journal of Medicine, several studies focus on the association between formulations of OCs and myocardial infarction. Evidence suggests that third-generation OCs are indeed safer than previous formulations in terms of the risk of cardiovascular disease. Any increase in the risk of myocardial infarction among current users is small, and past users of OCs have no lingering risk from that exposure. Appropriate treatment for hypertension and elevated lipid levels, along with moderate changes in lifestyle, could prevent the majority of cases of coronary disease. In this perspective, smoking remains of preeminent importance and greater priority on improving ways to aid smoking cessation and on reducing the number of young people who take up smoking should be implemented.
Language: English
Keywords:
CRITIQUE | DATA REPORTING | ORAL CONTRACEPTIVES | WOMEN | MYOCARDIAL INFARCTION | TOBACCO USE | Data Collection | Research Methodology | Contraceptive Methods | Contraception | Family Planning | Demographic Factors | Population | Heart Diseases | Diseases | Behavior
Document Number: 163047

27.
Peer Reviewed

Title: The relationship between use of oral contraceptives and myocardial infarction in young women with fatal outcome, compared to those who survive: results from the MICA case-control study.
Author: Dunn NR; Arscott A; Thorogood M
Source: Contraception. 2001 Feb;63(2):65-9.
Abstract: To examine the relationship between use of oral contraceptives (OCs) and the risk of dying from myocardial infarction, the authors made a comparison of deceased patients and live patients (women aged <45) identified for the Myocardial Infarction Causality case-control study, using data obtained from general practice medical notes. There were 422 live patients and 110 deceased patients of women with a myocardial infarction with data available. The adjusted odds ratio for exposure to second generation OCs and risk of death within 28 days of a myocardial infarction compared with no OC use was raised (2.88; 95% confidence interval, 1.22-6.77), and this effect was not seen for other types of OCs including third-generation OC formulations. In absolute terms, between 47,000 and 71,000 women would have to be exposed to a second-generation pill for 1 year to result in 1 extra death from myocardial infarction, and this risk applies mainly to smokers. The results suggest a slightly increased relative risk of death among those having a myocardial infarction associated with exposure to second generation OCs, but this represents a small absolute risk. Further work is required before any change in contraceptive practice should be advocated. (author's)
Language: English
Keywords:
UNITED KINGDOM | SCOTLAND | WALES | RESEARCH REPORT | CASE CONTROL STUDIES | ORAL CONTRACEPTIVES | MYOCARDIAL INFARCTION | WOMEN | RISK ASSESSMENT | United Kingdom | Europe, Western | Europe | Developed Countries | Studies | Research Methodology | Contraceptive Methods | Contraception | Family Planning | Heart Diseases | Diseases | Demographic Factors | Population | Evaluation
Document Number: 156487

28.
Title: Chronic infection with Chlamydia pneumoniae - a risk factor for acute myocardial infarction.
Author: Islam R; Zaman MA; Akhteruzzaman M; Majumdar AA; Lahiry S
Source: Diabetes and Endocrine Journal. 2001 Jan-Jun;29(1):19-25.
Abstract: Coronary heart disease is the commonest cause of morbidity and mortality in the" developed countries. Right now, it has become an emerging health problem in the developing countries like Bangladesh. Beside the established risk factors like smoking, hyperlipidemia, hypertension, diabetes mellitus and positive family history of ischemsic heart disease, infections particularly C pneumoniae infection is thought to be involved introducing atherosclerosis and at present it has become a major concern among the cardiologists all over the world. Having this new concept on atherosclerosis and matching the age and sex, 40 cases and 50 Controls were undergone investigations to detect C pneumoniae antibody IgG; three (7.5 %) out of 40 cases were found to be positive and all the Controls were undergone investigations to detect C pneumoniae antibody IgG; three (7.5 %) out of 40 cases were found to be positive and all the Controls were found to be negative. The result has shown that there is a tendency for correlation between chronic C pneumoniae infection with myocardial infarction (P=0.84). (author's)
Language: English
Keywords:
DEVELOPING COUNTRIES | BANGLADESH | RESEARCH REPORT | CASE CONTROL STUDIES | HEART DISEASES | MYOCARDIAL INFARCTION | PNEUMONIA | RISK FACTORS | TOBACCO USE | TREATMENT | ANTIBIOTICS | Asia, Southern | Asia | Studies | Research Methodology | Diseases | Pulmonary Effects | Physiology | Biology | Behavior | Drugs
Document Number: 178150


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