Contemporary hormonal contraceptives may be associated with an increased risk of stroke and myocardial infarction

1. The use of contemporary hormonal contraceptives was associated with an increased risk of ischemic stroke and myocardial infarction. 

Evidence Rating Level: 2 (Good)

Some evidence has suggested that the use of hormonal contraception is associated with an increased risk of ischemic stroke and myocardial infarction, but results are inconsistent across different studies. This nationwide, prospective cohort study therefore sought to investigate the association between contemporary hormonal contraceptive use and risk of incident ischemic stroke and myocardial infarction based on type of contraceptive and mode of administration. 2,025,691 Danish women between the ages of 15 and 49 received follow-up between January 1996 until July 2021. Compared to no use of hormonal contraception, use of oral contraceptives containing estrogen and progestin was associated with an adjusted incidence ratio of 2.0 (95% confidence interval (CI) 1.9 to 2.2) for ischaemic stroke and 2.0 (1.7 to 2.2) for myocardial infarction. The use of combined non-oral contraceptives was associated with an adjusted incidence rate ratio of 2.4 (95% CI 1.5 to 3.7) for ischaemic stroke and 3.8 (2.0 to 7.3) for myocardial infarction when compared to no use of hormonal contraception. Compared to no use of hormonal contraception, the use of progestin-only oral contraceptives was associated with adjusted incidence rate ratios of 1.6 (95% CI 1.3 to 2.0) for ischaemic stroke and 1.5 (1.1 to 2.1) for myocardial infarction. The use of progestin-only non-oral contraceptives was associated with an adjusted incidence rate ratio of 2.1 (95% CI 1.2 to 3.8) for ischemic stroke and 1.8 (0.8 to 4.4) for myocardial infarction compared with no use of hormonal contraception. Overall, this study found that the use of contemporary hormonal contraceptives was associated with an increased risk of ischemic stroke and myocardial infarction. 

Click to read the study in BMJ

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