Low-dose oral contraceptive use and the risk of myocardial infarction

Studies of oral contraceptives (OCs) containing 50 microg or more of estrogen suggest an increased risk of myocardial infarction (MI) among current users, particularly if they smoke heavily.

To assess whether use of the newer lower-dose OCs increases the risk of MI.

A case-control study was conducted from January 1985 through March 1999 in 75 hospitals in the greater-Boston and greater-Philadelphia areas. Data on OC use and MI risk factors were obtained by interview from 627 women with a nonfatal first MI (cases) and 2947 female hospital controls younger than 45 years.

The overall odds ratio (OR) for current OC use relative to never used was 1.3 (95% confidence interval [CI], 0.8-2. 2). The OR was elevated, 2.5 (95% CI, 0.9-7.5), among heavy smokers (>/=25 cigarettes per day) but close to 1.0 among lighter smokers (OR = 0.8) and nonsmokers (OR = 1.3). For current OC use together with heavy smoking relative to nonuse and nonsmoking, the OR was 32 (95 % CI, 12-81), considerably greater than that for heavy smoking alone, 12 (95% CI, 8.6-16). The ORs did not vary according to the type of formulation or the dose of estrogen; there were too few users to assess the new 20-microg preparations. Past OC use was unrelated to risk.

Current use of low-dose OCs in the United States is unrelated to an increased risk of MI among nonsmokers and light smokers, but users who smoke heavily may be at greatly increased risk.