Cardiovascular disease and steroid hormone contraception in Jamaica - abstract

ABSTRACT

Since hormone contraception became widely available in the early 1960s, there has been concern about its safety. On the other hand, its role in fertility management is crucial. Several reports suggest an association between hormonal contraception and cardiovascular disease, including venous thromboembolism, strokes and myocardial infarction. As part of a WHO multicentre study, we have examined the possible association between hormonal contraceptive use and cardiovascular disease in the Jamaican population. Since February 1988, all women from 20 years to 44 years old at last birthday, admitted to any hospital in Kingston and St. Andrew for venous thromboembolism, stroke or myocardial infarction were interviewed. Women were eligible for study, if this was the first episode of such an event and they were not pregnant or puerperal and had not had surgery or confinement to bed in the previous six weeks. Information on all hormonal contraceptive use was elicited during this interview and relevant clinical information from patient records. Three age-matched controls admitted within two months of the case's admission and 2 community controls living in the same neighbourhood were selected. To December 1988, there have been 51 cases 25 with thromboembolic disease and 26 with strokes. No myocardial infarctions were detected; 188 controls have been required. Use of hormonal contraception, past or present, was not shown to be associated with increased risk of these cardiovascular events. Contraceptive use was reported by 66 per cent of cases and 60 percent of controls. Current use (within the past 3 months) was reported in 25 percent of cases and 26 percent of controls. A history of hypertension was present more often among cases (14 percent versus 3 percent, p < 0.01). We have failed to show any association between the use of hormonal contraception and cardiovascular events in young Jamaican females. Hypertension has emerged as the only discriminating risk factor (AU)