Myocardial Infarction

Among users of third generation combined oral contraceptive(COC), the OR for current smokers was 3.75,  and among users of second generation it was 9.50. (13).

In conclusion, myocardial   infarction   in   women   taking   combined   hormonal contraceptives remains rare;  in fact,it has been estimated that the population attributable risk is less than three events in one million women years (3).

A logical hypothesis to explain the development of myocardial infarction would be an interaction between the hypercoagulability induced by COCs and the risk factors,known or unknown,in the users (15)

It is interesting to remember that antibodies to synthetic steroids (ethinylestradiol and progesterone) and circulating immune complexes were found in the serum of 30% of HC users and their titres are significantly higher in 90%  of women who develop vascular thrombosis unrelated to atherosclerosis (16,17).

In the last years, sporadic cases of myocardial infarction associated with hormonal contraceptive have been reported (17,18,19).

Women can minimize, and possibly eliminate entirely, their arterial risks by not smoking and by having their blood pressure checked before using a COC in order to avoid its use if elevated blood pressure is discovered.

The users may decrease their venous thromboembolic risk by their choice of COC preparation although the effects will be modest.  Thus,  reducing the hormone dosage of COCs and performing better screening of patients are needed to further reduce the frequency of cardiovascular complications. 

Rosa Sabatini and Giuseppe Loverro
Dept. Obstetrics and Gynecology,
General Hospital Policlinico-University of Bari, Italy

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