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Submitted on October 4, 2004
Accepted on March 24, 2005
Department of Internal Medicine, Université de Sherbrooke, Sherbrooke, Canada, J1H 5N4; Departments of Biostatistics, Internal Medicineand Obstetrics and Gynecology, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA 23298
* To whom correspondence should be addressed. E-mail: nestler{at}hsc.vcu.edu.
The long-term cardiovascular safety of widely used oral contraceptives (OCs) is still debated. There has not been a systematic review of the literature with appropriate aggregation of the results to assess specifically if the modern use of low-dose OCs is safe regarding all cardiovascular risks.
We rigorously reviewed all pertinent studies estimating the risk of cardiac or vascular arterial events associated with the current use of low-dose OCs, and applied a meta-analysis method to aggregate the results. All studies published between January 1980 and October 2002 were searched using online databases.
A total of 14 independent studies met our inclusion criteria. The summary risk estimates associated with current use of low-dose OCs were 1.84 (95%CI=1.38,2.44) for myocardial infarctions (MI) and 2.12 (95%CI=1.56,2.86) for ischemic strokes (IS). The overall summary odds ratio for both outcomes was 2.01 (95%CI=1.63,2.48). Second generation OCs were associated with a significant increased risk of both MI and IS events (1.85 [95% CI=1.03,3.32] and 2.54 [95%CI=1.96,3.28], respectively); and third generation OCs, for IS outcome only (2.03 [95%CI=1.15,3.57]).
In conclusion, a rigorous meta-analysis of the literature suggests that current use of low-dose OCs significantly increases the risk of both cardiac and vascular arterial events, including a significant risk of vascular arterial complications with third generation OCs.
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