Recently, new information has been published about : a) the relationship between combination oral contraceptives (OCs), estrogen dose, cigarette smoking, and the risk of myocardial infarction (MI) and stroke ; and b) the effect of different progestins on the risk of venous thromboembolism (VTE).
We review the epidemiologic data.
Regardless of age, in the absence of smoking, use of sub-50 mug OCs is not associated with any meaningful increase in risk of MI or stroke.
If the small, statistically nonsignificant elevations in risk for these diseases are assumed (for the sake of argument) to be causal, then the incidence of MI and stroke associated with use of OCs containing less than 50 mug ethinyl estradiol (EE) would be approximately 2 per 100,000 per year.
For women less than 35 years of age who do not smoke or do not have a history of hypertension, the risk would be even lower.
Any woman over the age of 35 who smokes should be advised to use a non-estrogen or nonhormonal contraceptive.
There are now two reports, from Jick et al. and Lewis et al., that demonstrate that the relative risk of Ml is certainly no greater for users of OCs containing desogestrel or gestodene than for users of OCs containing older progestins.
In fact, both show reduced relative risks for the newer progestins compared to the older ones. (...)
Mots-clés Pascal : Contraceptif, Voie orale, Thromboembolie, Accident cérébrovasculaire, Veine pathologie, Infarctus, Myocarde, Homme, Femelle, Toxicité, Oestroprogestatif, Oestrogène, Progestatif, Relation dose réponse, Appareil circulatoire pathologie, Vaisseau sanguin pathologie, Système nerveux pathologie, Système nerveux central pathologie, Encéphale pathologie, Cérébrovasculaire pathologie, Cardiopathie coronaire, Myocarde pathologie, Epidémiologie, Tabagisme, Article synthèse, Méthode combinée
Mots-clés Pascal anglais : Contraceptive, Oral administration, Thromboembolism, Stroke, Venous disease, Infarct, Myocardium, Human, Female, Toxicity, Estroprogestagen, Estrogen, Progestagen, Dose activity relation, Cardiovascular disease, Vascular disease, Nervous system diseases, Central nervous system disease, Cerebral disorder, Cerebrovascular disease, Coronary heart disease, Myocardial disease, Epidemiology, Tobacco smoking, Review
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0443161
Code Inist : 002B02U03. Création : 03/02/1998.