COMMENTARY

Stroke and MI Risk With Newer Hormonal Contraceptives

Alan R. Jacobs, MD

Disclosures

December 26, 2012

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This is the Medscape Neurology Minute. I am Dr. Alan Jacobs. Researchers from the University of Copenhagen in Denmark have published a 15-year Danish historical cohort study assessing the risk for thrombotic stroke and myocardial infarction associated with newer hormonal contraception. The participants were 1,626,158 nonpregnant women, 15-49 years of age, with no history of cardiovascular disease or cancer. During more than 14 million person-years of observation, 3311 thrombotic strokes and 1725 myocardial infarctions occurred. Compared with nonuse, current use of oral contraceptives that included ethinyl estradiol at doses of 30-40 µg was associated with relative risks (RR) for thrombotic stroke and myocardial infarction according to progestin type, as shown in Table 1.

Table 1. RR With 30- to 40-µg Dose by Progestin Type

  RR (30-40 µg Dose)
Progestin Type Thrombotic Stroke Myocardial Infarction
Norethindrone 2.2 2.3
Levonorgestrel 1.7 2.0
Norgestimate 1.5 1.3
Desogestrel 2.2 2.1
Gestodene 1.8 1.9
Drospirenone 1.6 1.7

 With ethinyl estradiol at a dose of 20 μg, the corresponding relative risks according to progestin type are shown in Table 2.

Table 2. RR With 20-µg Dose by Progestin Type

  RR (20 µg dose)
Progestin Type Thrombotic Stroke Myocardial Infarction
Desogestrel 1.5 1.6
Gestodene 1.7 1.2
Drospirenone 0.9 0

For transdermal patches, the corresponding RRs for thrombotic stroke and myocardial infarction were 3.2 and 0, and for a vaginal ring, 2.5 and 2.1, respectively. The investigators concluded that although the absolute risks for thrombotic stroke and myocardial infarction associated with the use of hormonal contraceptives were low, the risk was increased by a factor of 0.9-1.7 with oral contraceptives that included ethinyl estradiol at a dose of 20 μg, and by a factor of 1.3-2.3 with those that included ethinyl estradiol at a dose of 30-40 μg, with relatively small difference in risk according to progestin type.

This study was selected from Medscape's Practice-Changing Articles in Neurology. I'm Dr. Alan Jacobs.

Abstract

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