Modeled estimates of myocardial infarction and venous thromboembolic disease in users of second and third generation oral contraceptives

• Published in: Contraception (Stoneham) Vol. 55; no. 3; pp. 125 - 129
• Main Authors: Schwingl, Pamela J., Shelton, James
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.1997; Elsevier Science
• Subjects: Adolescent; Adult; Age Factors; Analysis. Health state; Biological and medical sciences; Cohort Studies; Contraceptives, Oral, Combined - adverse effects; Contraceptives, Oral, Synthetic - adverse effects; Desogestrel - adverse effects; Drug toxicity and drugs side effects treatment; Epidemiology; Female; General aspects; Humans; Incidence; Levonorgestrel - adverse effects; Medical sciences; Myocardial Infarction - chemically induced; Myocardial Infarction - epidemiology; Myocardial Infarction - mortality; Norethindrone - adverse effects; Norgestrel - adverse effects; Norgestrel - analogs & derivatives; Pharmacology. Drug treatments; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk Factors; Thrombophlebitis - chemically induced; Thrombophlebitis - epidemiology; Thrombophlebitis - mortality; Toxicity: cardiovascular system; United States - epidemiology; United States; North America; America; Human; Desogestrel; Infarct; Toxicity; Mortality; Oral administration; Cardiovascular disease; Risk; Coronary heart disease; Myocardial disease; Epidemiology; Morbidity; Progestagen; Vascular disease; Gestodene; Estroprogestagen; Myocardium; Female; Contraceptive; Thromboembolism; Age; Public health; Americas; Age Factors; United States; Biology; Research Methodology; North America; Oral Contraceptives > beneficial effects; Contraceptive Methods > beneficial effects; Oral Contraceptives, Combined > beneficial effects; Vascular Diseases; Heart Diseases; Population Characteristics; Population; Research Report; Demographic Factors; Models, Theoretical; Evaluation; Risk Assessment; Oral Contraceptives > side effects; Risk Factors; Contraception; Contraceptive Methods > side effects; Family Planning; Oral Contraceptives, Combined > side effects; Embolism; Diseases; Myocardial Infarction; Northern America; Developed Countries
• ISSN: 0010-7824; 1879-0518
• DOI: 10.1016/S0010-7824(97)00026-7

Consistent reports from several recent studies suggest that users of third generation oral contraceptives (OCs) containing gestodene and desogestrel may be at increased risk of venous thromboembolic disease (VTE). Paradoxically, other reports indicate that these users may be at decreased risk of acute myocardial infarction (MI) compared with users of second generation OCs. To determine whether the potentially increased risk of VTE would outweigh the potentially reduced risk of MI in users of third generation OCs, we conducted an analysis to quantify the trade-offs providers and users may be faced to make between these formulations. The baseline rates of VTE and MI among non-users were calculated using US data on incidence and mortality of these conditions and estimates of the proportion of women exposed to these formulations in the US. These were multiplied by relative risks published in recent studies on third generation progestins to produce age- and formulation-specific risks. Results indicate that there would be small differences in disease burden between users of second and third generation OCs under the model assumptions at younger ages. However, among women 35–44 years of age, modeling results indicate that the potentially decreased incidence of MI among users of third generation OCs more than offsets the potentially increased risk of VTE at this age.