Oral contraceptives and myocardial infarction: results of the MICA case-control study
Oral contraceptives and myocardial infarction: results of the MICA case-control study
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DOI：
10.1136/bmj.318.7198.1579
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发表时间：
1999-06-12
影响因子：
--
通讯作者：
Mann, R
中科院分区：
文献类型：
--
作者：
Dunn, N;Thorogood, M;Mann, R
目的：确定心肌梗死与年轻女性使用不同类型口服避孕药之间的关系。数据来自访谈和一般的实践记录。设置英格兰，苏格兰和Wales.Participants情况下（n = 448）被招募的妇女年龄在16岁至44岁之间，谁遭受了1993年10月1日和1995年10月16日之间的事件心肌梗死。控制（n = 1728）是年龄和一般实践相匹配的未诊断为心肌梗死的妇女。主要结果测量与非使用者相比，当前使用所有组合口服避孕药的患者中心肌梗死的比值比，根据其孕激素含量分层;目前使用第三代和第二代口服避孕药的患者。结果心肌梗死的校正比值比为1.40（95%置信区间0.78 - 2.52），第二代使用者1.10（0.52 - 2.30），第三代使用者1.96（0.87 - 4.39）。按孕激素含量进行的亚组分析显示，与1相比没有任何显著差异，使用时间也没有影响。第三代使用者与第二代使用者的调整优势比为1.78（0.66至4.83）。87%的病例未使用口服避孕药，88%的病例有临床心血管风险因素或吸烟者，或两者兼而有之。吸烟与心肌梗死密切相关：调整后的比值比为12.5（7.29至21.5）吸烟20支或以上的一天。结论口服避孕药的使用和心肌梗死之间没有显着的关联。这种关联的适度和非显著点估计具有较宽的置信区间。第二代和第三代产品之间没有显著差异。
Objectives To determine the association between myocardial infarction and use of different types of oral contraception in young women.Design Community based case-control study. Data from interviews and general practice records.Setting England, Scotland, and Wales.Participants Cases (n = 448) were recruited from women aged between 16 and 44 who had suffered an incident myocardial infarction between 1 October 1993 and 16 October 1995. Controls (n = 1728) were women without a diagnosis of myocardial infarction matched for age and general practice.Main outcome measures Odds ratios for myocardial infarction in current users of all combined oral contraceptives stratified by their progestagen content compared with non-users; current users of third generation versus second generation oral contraceptives.Results The adjusted odds ratio for myocardial infarction was 1.40 (95% confidence interval 0.78 to 2.52) for all combined oral contraceptive users, 1.10 (0.52 to 2.30) for second generation users, and 1.96 (0.87 to 4.39) for third generation users. Subgroup analysis by progestagen content did not show any significant difference from 1, and there was no effect of duration of use. The adjusted odds ratio for third generation users versus second generation users was 1.78 (0.66 to 4.83). 87% of cases were not exposed to an oral contraceptive, and 88% had clinical cardiovascular risk factors or were smokers, or both. Smoking was strongly associated with myocardial infarction: adjusted odds ratio 12.5 (7.29 to 21.5) for smoking 20 or more cigarettes a day.Conclusions There was no significant association between the use of oral contraceptives and myocardial infarction. The modest and non-significant point estimates for this association have wide confidence intervals. There was no significant difference between second and third generation products.