Cardiovascular death among women under 40 years of age using low-estrogen oral contraceptives and intrauterine devices in Finland from 1975-1984

Article Abstract:

There is a strong association between use of oral contraceptive pills and cardiovascular disease. In Finland, the two most popular birth control methods are the intrauterine device (IUD) and birth control pills. IUDs are offered to women who are over 30 years of age who have already had children. Oral contraceptives are offered to women who are under 40 but are not advised for women under 30 who smoke. The early birth control formulas, which contained high doses of estrogen and progesterone, have been replaced by low-dose formulas. The risk of fatal cardiovascular disease was studied among 1,585,000 women who used oral contraceptives and 1,975,000 women who used a copper-bearing IUD. Between 1975 and 1984 autopsy reports confirmed the cause of death in 89 percent of the cases. Among women between 15 and 39 years of age, there were 20 deaths caused by pulmonary embolism (blood clot in the lungs), 41 deaths from coronary heart disease, 311 intracranial hemorrhages (bleeding in the brain). Of the 20 women who died from a pulmonary embolism, four were on the pill, for a risk 1.2 times greater than those who did not take the pill. None of the four women had any other risk factors for pulmonary embolism, and none of the women under the age of 40 who used a copper IUD died from pulmonary embolism. The relative risk for intracranial hemorrhage was 1.18 for women who used the copper IUD. It is concluded that low-dose oral contraceptives are associated with a slight excess risk for pulmonary embolism (one death per one million pill users). The pill is relatively safe to use in nonsmoking women who have no known coronary heart disease risk factors and no family history of heart disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Finland, Cardiovascular diseases, Causes of, Pulmonary embolism, Intrauterine contraceptives, Intrauterine devices

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An epidemiologic survey of cardiovascular disease in women taking oral contraceptives

Article Abstract:

Women who take oral contraceptives are at risk for cardiovascular disease. Previous British studies examining the effects of oral contraceptives on fatal disease are reviewed. The most consistent finding is an increased risk for myocardial infarction, heart attack. Women who take oral contraceptives are two to four times more likely to have a myocardial infarction and 1.4 times more likely to have a stroke. The risk for heart disease is increased further if the woman is older or smokes. Deaths usually occur during the period the pill is actually taken and the risk is not affected by previous use. Since the association between oral contraceptive use and heart disease has emerged, formulas for ''the pill'' have changed. The newer pills deliver lower doses of estrogen and progesterone in biphasic or triphasic 28-day cycles. In addition, some pills are progesterone-only pills. Preliminary results of an ongoing study examining the cardiovascular risks with the low-dose formulas are reported. In this study, women who used oral contraceptives were 1.8 times more likely to die from cardiovascular disease. That risk was increased 12-fold for women who smoked. The risk of bleeding in the brain (subarachnoid hemorrhage) was 1.4 for women who used oral contraceptives, which increased to 3.1 for women who smoked. The change in oral contraceptive formulas has appeared to lower the risk for myocardial infarction and subarachnoid hemorrhage, but women who smoke and use birth control pills are still 50 times more likely to suffer a heart attack. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Heart attack, Tobacco

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The effect of triphasic oral contraceptives on plasma lipids and lipoproteins

Article Abstract:

The triphasic birth control pill delivers the hormones progesterone and estrogen in dosages resembling the hormonal pattern of a normal menstrual cycle. That is, the hormone combination and dose is different in week one than in weeks two and three. Early studies on higher hormone dosage formulas described a relationship between pill use and heart disease, particularly heart attack and stroke. The effects of triphasic pills on blood lipid transport (elevated blood lipids increase the risk for heart disease) were studied in 150 nonsmoking women. Three different formulas were evaluated over a six-month period. There was an increase in blood triglycerides (28 to 52 percent) and apolipoprotein B levels (20 to 23 percent) in all groups. There were very slight increases in cholesterol (0 to 11 percent) and low-density lipoproteins (20 to 23 percent). Changes in the total high-density lipoproteins were insignificant. However, high-density lipoprotein 2, the HDL thought to be protective against heart disease, was increased by 29 to 33 percent. It is unclear how these blood lipid changes affect the probability of coronary heart disease in users of oral contraceptives. The results were similar in all three types of triphasic pills.

Measurement, Blood lipids, Lipoproteins, Blood lipoproteins

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