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Human Reproduction, Vol. 17, No. 9, 2307-2314, September 2002
© 2002 European Society of Human Reproduction and Embryology

Myocardial infarction and third generation oral contraceptives: aggregation of recent studies

Walter O. Spitzer1,4, Janet M. Faith2 and Kenneth D. MacRae3,*

1 Emeritus Professor of Epidemiology and 2 Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada and 3 Professor of Medical Statistics, University of Surrey, Guildford, Surrey, UK

BACKGROUND: Arterial cardiovascular and cerebrovascular adverse events associated with oral contraceptives (OC) are a major concern to the clinician. This paper aggregates the findings of seven recent oral contraceptive studies on the risk of acute myocardial infarction (MI) among users of second (2gen) and third (3gen) generation OC. METHODS: Odds ratios (OR) from seven original studies published between 1996 and 2001 underwent meta-analysis. They had accrued 6464 subjects since 1996. In addition, estimates of 22 studies published from 1965 to 1966 were synthesized using medians and ranges as an historical point of reference. RESULTS: Four meta-analyses were performed for each of the relevant comparisons. The point estimates for 3gen versus 2gen OC ranged from 0.44 (0.24–0.80) to 0.62 (0.38–0.99). Compared with non-users, the aggregated OR for 3gen OC was 1.13 (0.66–1.92); for 2gen OC it was 2.18 (1.62–2.94). CONCLUSIONS: This overview of seven controlled observational studies confirms that 3gen OC do not convey harm in regard to MI compared with non-users of OC. The aggregate data and the continuing replication of findings allow interpretation of benefit compared with older combined OC.

Key words: case–control study/epidemiology/myocardial infarction/oral contraceptives

* Sadly, Dr Kenneth D.MacRae died shortly after acceptance for publication of this paper.

4 To whom correspondence should be addressed at: 4920 Bath Rd., Bath by Kingston, Ontario, K0H 1G0, Canada.


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