Coronary atherosclerosis and myocardial infarction in young women -- role of oral contraceptives

According to their coronary anatomy and use of oral contraceptives,76 patients aged 50 years with a history of acute myocardialinfarction were allocated to one of four groups: groups I andII with contraceptive history without (g. I, n = 27) or with(gr. II, n = 15) coronary atherosclerosis, groups III and IVwithout oral contraceptive history with (gr. III, n = 27) orwithout (gr. IV, n = 7) coronary atherosclerosis. The patientswere analysed with regard to their history, the incidence ofatherogenic risk factors, and coronary and left ventricularangiograms. Among 34 patients with myocardial infarction without coronaryatherosclerosis (gr. I and IV), 27 had been using oral contraceptivesat the time of myocardial infarction; with the exception ofcigarette smoking, the incidence of atherogenic risk factorswas low in this group. The analysis of atherogenic risk factorsdid not allow estimation of the susceptibility to cardiovascularside effects of oral contraceptives. Young women with typicalcoronary atherosclerosis (gr. II and III) had an unusually highincidence of atherogenic risk factors; oral contraceptives wereused by 15 of 42 of these patients. Among patients who had sustained a myocardial infarction duringoral contraceptive medication, 64% did not have coronary atherosclerosisangiographically. Thus, myocardial infarctions under oral contraceptivesmay be a discrete disease entity unrelated to coronary atherosclerosis.Although oral contraceptives appear to increase the risk ofmyocardial infarction, they are not a typical atherogenic riskfactor.