From the Division of Research, Kaiser Permanente Medical Care Program,
Northern California, Oakland (S.S., C.P.Q.); Cardiovascular Health Research
Unit (D.S.S., S.M.S., B.M.P., T.D.K.), Department of Epidemiology, School of
Public Health and Community Medicine (D.S.S, S.M.S., B.M.P., T.D.K), Division
of General Internal Medicine, Department of Medicine, School of Medicine
(D.S.S.), and Department of Biostatistics, School of Public Health and
Community Medicine (T.E.R.), University of Washington, Seattle; Research and
Evaluation, Kaiser Permanente Medical Care Program, Southern California,
Pasadena (D.B.P.); and the Contraceptive and Reproductive Evaluation Branch,
National Institute of Child Health and Human Development, Bethesda, Md (J.K.).
Dr Raghunathan is now at the Department of Biostatistics, University of
Michigan, Ann Arbor.
Correspondence to Stephen Sidney, MD, MPH, Kaiser Permanente Division of Research, 3505 Broadway, Oakland, CA 94611. E-mail sxs{at}dor.kaiser.org
Background—Population-based
case-control studies to assess the relationship of low-dose oral
contraceptive (OC) use with myocardial infarction (MI) were performed
at 2 sites in the United States (California and Washington state). The
purpose of the present study was to estimate risk of MI in relation
to use of low-dose OCs in a pooled analysis combining results
from the 2 sites.
Methods and Results—The study included as cases women aged 18 to
44 years with incident MI who had no prior history of ischemic
heart disease or cerebrovascular disease. Women in the case and control
groups were interviewed in person regarding OC use and
cardiovascular risk factors. The analysis
included 271 MI cases and 993 controls. Compared with noncurrent users,
the adjusted pooled odds ratio for MI in current OC users was 0.94
(95% CI, 0.44, 2.20) after adjustment for major risk factors and
sociodemographic factors. Compared with never users, the adjusted
pooled odds ratio for MI was 0.56 (0.21, 1.49) in current OC users and
0.54 (0.31, 0.95) in past OC users. Among past OC users, duration and
recency of use were unrelated to MI risk as was current hormone
replacement therapy. There was no evidence of interaction between OC
use and age, presence of cardiovascular risk factors
(hypercholesterolemia, hypertension, diabetes),
obesity, or smoking.
Conclusions—We conclude that low-dose OCs as used in these
populations are safe with respect to risk of MI in women.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Myocardial Infarction and Use of Low-Dose Oral Contraceptives
A Pooled Analysis of 2 US Studies
Key Words: women • myocardial infarction • epidemiology • risk factors
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