Contraception and risk factors in young women with myocardial infarction: The WAMIF study

Cardiovascular disease has a rising incidence in young women. Women are exposed to both classical risk factors and sex-specific risk factors. We analyzed the combination of hormonal contraception and classical cardiovascular risk factors, and emergent risk factors in women under 50 admitted for acute myocardial infarction (MI).

The WAMIF study was a multicenter, prospective, observational study including 314 women with MI under 50 years in France. Forty-three women used a combined contraception (COC), 70 used progestin-only contraception, and 147 did not use any hormonal contraception. We compared the classical risk factors for MI in each group and other risk factors such as pregnancy complications and precarity using standard statistical tests. Preventable events were computed using the formula of an attributable risk fraction where RR is relative risk: [(1-RR/RR].

86 % (37/43) of the women using COC, at the time of the MI, had between two and seven classical risk factors for MI, which were contraindications, indicating a preventable fraction of 43.0 % (95 %CI 35.4-46.9). Smoking was the most frequent factor (35/43). Thirty-six women were 35 years or older, and 32 hadat least one other risk factor: mainly hypertension and dyslipidemia. Overall, 100 women (31.8 %) had experienced at least one pregnancy with a complication, which is higher than the rate reported in the general population.

MI in women using COC could be largely avoidable if recommendations for contraception were more strictly respected. Evaluating the impact of other emergent risk factors, including precarity, to stratify indications is crucial.