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Associations of hormonal contraceptives and infertility medications on the risk of venous thromboembolism, ischemic stroke, and cardiovascular disease in women
  1. Shu-qi Ge1,
  2. Xin Tao2,
  3. Li-si Cai2,
  4. Xuan-ying Deng2,
  5. Muh-fa Hwang3,
  6. Chiung-lang Wang3
  1. 1 Department of Infertility and Sexual Medicine, the Third Affiliated Hospital, Sun-Yet Sen University, Guangzhou, People’s Republic of China
  2. 2 Center for Reproductive Medicine, the Third Affiliated Hospital, Sun-Yet Sen University, Guangzhou, People’s Republic of China
  3. 3 Department of Obstetrics and Gynecology, Min-Sheng General Hospital, Taoyuan, Taiwan
  1. Correspondence to Dr Xin Tao, Center for Reproductive Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, People’s Republic of China; doctort{at}163.com

Abstract

The purpose of this study was to examine the relations of hormonal contraceptives and infertility drugs with the risk of venous thromboembolism (VTE), deep vein thrombosis (DVT), pulmonary embolism (PE), ischemic stroke, and cardiovascular disease. The Taiwan National Health Institute Research Database was searched for women who had taken hormonal contraceptives or infertility medications from 2000 to 2010. The two groups were age and index date matched with controls (1:4 ratios). Cox regression analysis was used to examine the risks of VTE, DTE, PE, ischemic stroke, and cardiovascular disease. A total of 32,067 women were included in the hormonal contraceptives group and 4710 in the infertility medications group (matched controls: 127,872 and 18,840, respectively). After adjustment for age, comorbidities, and other confounders, the contraceptives group had a higher risk of VTE (adjusted HR 1.14, 95% CI 1.004 to 1.30) and cardiovascular disease (adjusted HR 1.30, 95% CI 1.26 to 1.34), and lower risk of ischemic stroke (adjusted HR 0.90, 95% CI 0.86 to 0.95). The infertility medications group had a higher risk of VTE (adjusted HR 1.996, 95% CI 1.41 to 2.72) and DVT (adjusted HR 1.86, 95% CI 1.31 to 2.63), and lower risk of ischemic stroke (adjusted HR 0.82, 95% CI 0.68 to 0.99) and cardiovascular disease (adjusted HR 0.83, 95% CI 0.74 to 0.94). Hormonal contraceptives and infertility medications appear to lower the risk of ischemic stroke and increase the risk of VTE; however, their effect on the risk of other types of cardiovascular events varies.

  • hormonal contraceptives
  • infertility
  • venous thromboembolism
  • deep vein thrombosis
  • ischemic stroke
  • cardiovascular disease

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Footnotes

  • Contributors XT: conception and design, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript, final approval of the manuscript, and guarantor of integrity of the entire study. S-qG: conception and design, acquisition of data, drafting of the manuscript, final approval of the manuscript, and statistical analysis. LC: acquisition of data, analysis and interpretation of data, critical revision of the manuscript, final approval of the manuscript, and literature research. X-yD: acquisition of data, drafting of the manuscript, and final approval of the manuscript. M-fH and C-lW: acquisition of data, critical revision of the manuscript, and final approval of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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