Lowered risk of dying of heart attack with third generation pill may offset risk of dying of thromboembolism

Reported in this letter are the final results of a transnational case-control study on oral contraceptives (OCs) and myocardial infarction. 182 women 16-44 years of age with myocardial infarction were recruited to the study at 16 European centers in 1993-96; 635 hospital and community-based healthy women matched by age group and site served as controls. Documented in linear trend analysis was a clear decrease in risk from first to third generation OCs. The odds ratios (ORs) were 4.66 (95% confidence interval (CI) 1.52-14.33) for women who used first-generation OCs 2.99 (95% CI 1.51-5.91) for second-generation OCs and 0.85 (95% CI 0.30-2.39) for third-generation pills. The OR for current use of third-generation OCs compared with current use of second-generation pills was 0.28 (95% CI 0.09-0.87). Finally the OR for the risk of myocardial infarction was 7.2 (95% CI 4.6-11.4) when current smoking was adjusted for OC use. The expected reduction in deaths from myocardial infarction associated with third-generation OCs should offset any excess deaths associated with venous thromboembolism.