Hormonal Contraceptives Linked to Increased Stroke and Heart Attack Risks
The risks of suffering a stroke or a heart attack are elevated with the use of certain hormonal contraceptives, as highlighted by a recent study published in The BMJ.
Study Finds Increased Risks
The study, which examined various forms of hormonal contraceptives, revealed that estrogen-based products pose the greatest risk. However, researchers emphasized that the absolute risk remains relatively low.
Global Usage of Hormonal Contraceptives
Hormonal contraceptives are widely used, with over 250 million women around the world relying on them. Previous research has yielded inconsistent results regarding the association between these contraceptives and stroke or heart attack risks.
Research Objectives and Methodology
To address the lack of clear evidence, a study was conducted involving Danish women aged 15 to 49 between 1996 and 2001. Participants were free from pre-existing conditions such as thrombosis, liver disease, cancer, and kidney disease.
Data was collected from multiple sources including medical records, birth registers, and prescription databases. The study followed participants until death, emigration, or July 1, 2021.
Current vs. No Contraceptive Users
Women with a filled prescription for any hormonal contraceptive were categorized as current users. The type and quantity of the contraceptive were recorded. The duration of use for oral, ring, patch, and injection methods was determined by the number of daily doses purchased.
Cardiovascular Event Rates
The rate of ischemic stroke for those using combined oral contraceptives was found to be 39 per 100,000 person years, while the rate of myocardial infarctions was 18 per 100,000 person years.
Risk Ratios for Different Contraceptives
Compared to no hormonal contraception, using oral contraceptives containing both estrogen and progestin doubled the incidence rate ratio for both ischemic stroke and myocardial infarction. This translates to 21 and 10 additional events per 100,000 person years, respectively.
For combined oral contraceptives with 20 μg of ethinyl estrogen, the risk ratio for ischemic stroke was 1.9, rising to 2 for those with 30 to 40 μg. For myocardial infarctions, the ratios were 1.6 and 2.1, respectively.
The combined vaginal ring was associated with a risk ratio of 2.4 for ischemic stroke and 3.8 for myocardial infarction, corresponding to additional incidences of 28 and 41 per 100,000 person years.
The hormonal patch posed a significant risk for ischemic stroke with an adjusted risk ratio of 3.4, although no cases of myocardial infarction were observed among users. Progestin-only oral contraceptives were linked to rates of 33 and 13 per 100,000 person years for ischemic stroke and myocardial infarction, respectively.
Implications for Healthcare Providers
These findings suggest that the use of certain hormonal contraceptives increases the risk of ischemic stroke and myocardial infarction. Health professionals are advised to consider these risks when evaluating the overall benefits versus risks of hormonal birth control methods.
Conclusion
The study provides valuable insights into the relationship between hormonal contraceptives and cardiovascular health. While the absolute risks remain low, healthcare providers should discuss these findings with patients to make informed decisions about their birth control options.
Understanding and addressing these risks is crucial for ensuring the well-being of women who use hormonal contraceptives.
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