BMJ 1999;319:1199 ( 30 October )

Letters

Study confirms tendency towards lower risk of myocardial infarction with second generation oral contraceptives in UK

The first 150 words of the full text of this article appear below.

EDITOR---Lidegaard is mistaken in his commentary on the MICA study of oral contraceptives and myocardial infarction.1 Third generation oral contraceptives were, in fact, preferentially prescribed to women at lower risk of myocardial infarction. The odds ratios of third versus second generation pills increased rather than decreased when more potential confounders were entered into the logistic model.1 Similar preferential prescribing in favour of third generation contraceptives was found in the only empirical study of prescribing in the United Kingdom.2

The MICA study should now lay to rest the lipid hypothesis of oral contraceptives and myocardial infarction, which was influential in the massive shift in prescribing to third generation pills (which have less effect on blood lipid concentrations) in the early 1990s. Angiography after myocardial infarction has shown that oral contraceptive users have little atherosclerosis, which is consistent with repeated epidemiological findings that past use of oral contraceptives does not . . . [Full text of this article]
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Relevant Article

Oral contraceptives and myocardial infarction: results of the MICA case-control study • Commentary: Oral contraceptives and myocardial infarction: reassuring new findings
Nicholas Dunn, Margaret Thorogood, Brian Faragher, Linda de Caestecker, Thomas M MacDonald, Charles McCollum, Simon Thomas, Ronald Mann, and Øjvind Lidegaard
BMJ 1999 318: 1579-1584. [Abstract] [Full Text] [PDF]

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