Potential impact of oral contraceptive choice on myocardial infarction mortality and deep vein thrombosis.
OBJECTIVE
To summarise the epidemiological evidence on the relationship between second- (OC2) and third-generation (OC3) oral contraceptives (OC) and the mortality associated with deep vein thrombosis (DVT) and myocardial infarction (MI), and to extrapolate and balance the evidence for these risks to the population of French OC users.


METHODS
All studies published on the risk of MI during OC2 and OC3 use were analysed. For DVT the Committee for Proprietary Medicinal Products public assessment report published in 2001 and more recent studies published on this topic were used. The estimates of odds ratios (OR) for risk of death from DVT or MI were extracted from the published manuscripts. ORs were used to calculate the aetiological fraction of risk for death from DVT and MI in the population; the relative impact of OC3 compared to OC2 use was expressed as an excess risk of death overall and by age group for French women.


RESULTS
Compared with OC2, the use of OC3 would prevent a maximum of 24 deaths from MI per year and induce a maximum of 16 deaths. Conversely, OC3 would induce 282-940 excess cases of DVT per year, resulting in 28-94 pulmonary embolisms and 3-19 deaths in the 4.7 million French OC users.


CONCLUSIONS
Balancing the evidence, it is difficult to conclude that the overall cardiovascular risk is significantly lower for either of the two OC schemes.
Martin
Karin
K
Department of Pharmacology, Victor Segalen University, Bordeaux, France. karin.martin@pharmaco.u-bordeaux2.fr
Moride
Yola
Y
Metge
Colleen
C
Moore
Nicholas
N
Bégaud
Bernard
B
D000328:Adult; D000367:Age Factors; D003276:Contraceptives, Oral / Q000009:adverse effects*; D016021:Epidemiologic Studies; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D009203:Myocardial Infarction / Q000401:mortality*; D016017:Odds Ratio; D018570:Risk Assessment; D012307:Risk Factors; D020246:Venous Thrombosis / Q000401:mortality*
D003276:Contraceptives, Oral