Ischemic Stroke Risk Higher With Use of Contemporary Hormonal Contraceptives
FRIDAY, Feb. 14, 2025 -- Contemporary estrogen-progestin contraceptives are associated with an increased risk for ischemic stroke and myocardial infarction, according to a study published online Feb. 12 in The BMJ.
Harman Yonis, M.D., from Nordsjaellands Hospital in Hilleroed, Denmark, and colleagues examined the association between contemporary hormonal contraceptive use and the risk for incident ischemic stroke and myocardial infarction in a real-world prospective cohort study.
A total of 4,730 ischemic strokes and 2,072 myocardial infarctions occurred among 2,025,691 women followed for 22,209,697 person-years. The researchers found that the standardized ischemic stroke rates were 18, 39, 33, and 23 per 100,000 person-years for no use, combined oral contraception, progestin-only pills, and intrauterine device, respectively. The corresponding standardized rates for myocardial infarction were 8, 18, 13, and 11 per 100,000 person-years. Current use of combined oral contraception was associated with an adjusted rate ratio of 2.0 for both ischemic stroke and myocardial infarction compared with no use, corresponding to standardized rate differences of 21 and 10 extra ischemic strokes and extra myocardial infarctions, respectively, per 100,000 person-years. Current use of progestin-only pills was associated with an adjusted rate ratio of 1.6 and 1.5 for ischemic stroke and myocardial infarction, respectively, compared with no use, equating to 15 and four extra ischemic strokes and extra myocardial infarctions, respectively, per 100,000 person-years. Increased arterial thrombotic risk was seen with use of the combined vaginal ring, patch, and progestin-only implant, but no increased risk was seen with the progestin-only intrauterine device.
"Given the widespread use of these products and the severity of arterial thrombotic events, the findings have important public health implications," the authors write.
Several authors disclosed ties to the pharmaceutical industry.
Disclaimer: Statistical data in medical articles provide general trends and do not pertain to individuals. Individual factors can vary greatly. Always seek personalized medical advice for individual healthcare decisions.
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