IHD and combined oral contraceptives

• the current evidence suggests that there is no detectable increase in the risk of myocardial infarction with either second- or third-generation pills in women with no additional risk factors
• a Drug and Therapeutics bulletin review (1) suggests that the risk of myocardial infarction in women taking either second- or third-generation combined oral oral contraceptive pills seems only to increase when associated with an additional risk factor such as obesity, smoking, hyperlipidaemia, hypertension, diabetes mellitus or a family history of myocardial infarction
• a MeReC review states that (2):
  • absolute risk of a MI in young non-smoking women with no cardiovascular risk factors is very low, whether or not they take COCs
  • COCs are associated with a very small increase in the absolute risk of ischaemic stroke in non-smoking, normotensive women
  • COCs should be used with caution in any woman with risk factors for cardiovascular disease (e.g. obesity, age over 35 years, smoking) and avoided in women with severe or multiple risk factors
• the BNF suggests that the oral contraceptive pill should be used with caution if there is one risk factor for arterial disease but should be avoided if there are two or more risk factors present (see linked item)

Reference:

1. Drug and Therapeutics Bulletin (2000); 38 (1): 1-5.
2. MeReC Bulletin 2006;17(2):1-9.