Thrombotic Stroke and Myocardial Infarction with Hormonal Contraception
Thrombotic Stroke and Myocardial Infarction with Hormonal Contraception
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DOI：
10.1056/nejmoa1111840
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发表时间：
2012-06-14
影响因子：
158.5
通讯作者：
Keiding, Niels
中科院分区：
文献类型：
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作者：
Lidegaard, Ojvind;Lokkegaard, Ellen;Keiding, Niels
虽然有几项研究已经评估了静脉血栓栓塞的风险与新的激素避孕药，很少有研究血栓性中风和心肌梗死，结果一直contradiction. METHODS在这15年的丹麦历史队列研究，我们遵循非妊娠妇女，15至49岁，没有心血管疾病或癌症的历史。从四个国家登记处获得了关于激素避孕药使用、临床终点和潜在混杂因素的数据。（21.4/100，000人-年）和1725例心肌梗死（10.1/100，000人-年）。与不使用避孕药相比，目前使用包含炔雌醇的口服避孕药（剂量为30 - 40 μ g）与下列相对风险相关血栓性卒中和心肌梗死（和95%置信区间），根据炔诺酮类型：炔诺酮，2.2（1.5至3.2）和2.3（1.3至3.9）;左炔诺孕酮，1.7（1.4至2.0）和2.0（1.6至2.5）;诺孕酯，1.5（1.2至1.9）和1.3（0.9至1.9）;去氧孕烯，2.2（1.8至2.7）和2.1（1.5至2.8）;孕二烯酮，1.8（1.6至2.0）和1.9（1.6至2.3）;屈螺酮，分别为1.6（1.2至2.2）和1.7（1.0至2.6）。炔雌醇剂量为20 μ g时，根据炔雌醇类型，相应的相对风险如下：去氧孕烯，1.5（1.3 - 1.9）和1.6（1.1 - 2.1）;孕二烯酮，1.7（1.4 - 2.1）和1.2（0.8 - 1.9）;屈螺酮，0.9（0.2 - 3.5）和0.0。对于透皮贴剂，相应的相对风险为3.2（0.8至12.6）和0.0，对于阴道环，2.5（1.4至4.4）和2.1（0.7 ~ 6.5）。结论：尽管与使用激素避孕药相关的血栓性中风和心肌梗死的绝对风险较低，口服避孕药包括剂量为20 μ g的炔雌醇的风险增加0.9至1.7倍，口服避孕药包括剂量为30至40 μ g的炔雌醇的风险增加1.3至2.3倍，根据炔雌醇类型，风险差异相对较小。（由丹麦心脏协会资助。
BACKGROUNDAlthough several studies have assessed the risk of venous thromboembolism with newer hormonal contraception, few have examined thrombotic stroke and myocardial infarction, and results have been conflicting.METHODSIn this 15-year Danish historical cohort study, we followed nonpregnant women, 15 to 49 years old, with no history of cardiovascular disease or cancer. Data on use of hormonal contraception, clinical end points, and potential confounders were obtained from four national registries.RESULTSA total of 1,626,158 women contributed 14,251,063 person-years of observation, during which 3311 thrombotic strokes (21.4 per 100,000 person-years) and 1725 myocardial infarctions (10.1 per 100,000 person-years) occurred. As compared with nonuse, current use of oral contraceptives that included ethinyl estradiol at a dose of 30 to 40 mu g was associated with the following relative risks (and 95% confidence intervals) for thrombotic stroke and myocardial infarction, according to progestin type: norethindrone, 2.2 (1.5 to 3.2) and 2.3 (1.3 to 3.9); levonorgestrel, 1.7 (1.4 to 2.0) and 2.0 (1.6 to 2.5); norgestimate, 1.5 (1.2 to 1.9) and 1.3 (0.9 to 1.9); desogestrel, 2.2 (1.8 to 2.7) and 2.1 (1.5 to 2.8); gestodene, 1.8 (1.6 to 2.0) and 1.9 (1.6 to 2.3); and drospirenone, 1.6 (1.2 to 2.2) and 1.7 (1.0 to 2.6), respectively. With ethinyl estradiol at a dose of 20 mu g, the corresponding relative risks according to progestin type were as follows: desogestrel, 1.5 (1.3 to 1.9) and 1.6 (1.1 to 2.1); gestodene, 1.7 (1.4 to 2.1) and 1.2 (0.8 to 1.9); and drospirenone, 0.9 (0.2 to 3.5) and 0.0. For transdermal patches, the corresponding relative risks were 3.2 (0.8 to 12.6) and 0.0, and for a vaginal ring, 2.5 (1.4 to 4.4) and 2.1 (0.7 to 6.5).CONCLUSIONSAlthough the absolute risks of thrombotic stroke and myocardial infarction associated with the use of hormonal contraception were low, the risk was increased by a factor of 0.9 to 1.7 with oral contraceptives that included ethinyl estradiol at a dose of 20 mu g and by a factor of 1.3 to 2.3 with those that included ethinyl estradiol at a dose of 30 to 40 mu g, with relatively small differences in risk according to progestin type. (Funded by the Danish Heart Association.)