ArticleBMJ (Clinical research ed.)2025
Stroke and myocardial infarction with contemporary hormonal contraception: real-world, nationwide, prospective cohort study.
Article in BMJ (Clinical research ed.), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 1 of them a synthesis that pooled it.
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Who cites it
17 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Polycystic ovary syndrome with stroke, hypertension, and cardiovascular diseases: a systematic review and meta-analysis.BMC women's health · 2025Pooled it
- Adolescent Hormonal Contraceptive Use in the Context of Brain Development and Depression Risk: A Review and Considerations for Future Research.Biological psychiatry global open science · 2026Review
- An integrated investigation of systemic and localized pathophysiological mechanisms of stroke and multimodal therapeutic strategies.Zhong nan da xue xue bao. Yi xue ban = Journal of Central South University. Medical sciences · 2026Review
- Beyond the review: additional non-oncologic drugs with clinically significant cardiovascular effects.European heart journal. Cardiovascular pharmacotherapy · 2026Article
- Ischemic stroke due to non-atherosclerotic aortic mural thrombus associated with iron deficiency anemia successfully treated with surgery.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2026Article
- Combined oral contraceptive use as a cause of acute myocardial infarction in a young woman without traditional risk factors: a case report.Journal of medical case reports · 2026Article
- Prescribed hormonal contraceptive use trends in the Estonian Biobank: A longitudinal observational study.PLoS medicine · 2026Observational
- Interplay of Total Antioxidant Capacity and Oxidative Stress Hydroperoxides with Circulating Biomarkers of Inflammation and Iron Status According to Oral Contraception Use.Antioxidants (Basel, Switzerland) · 2026Article
- Cardiovascular Safety of Hormonal Contraception: Method-Specific Risks and Clinical Implications.Medical sciences (Basel, Switzerland) · 2026Review
- Medical Treatment for Endometriosis: One Size Does Not Fit All.Journal of clinical medicine · 2026Review
- How We Can Optimize Dysmenorrhea Treatment: Real-World Results from a Cross-Sectional, Multi-Center Study.Geburtshilfe und Frauenheilkunde · 2026Article
- Sex Hormone Supplementation and Cardiovascular Disease Risk.Medicina (Kaunas, Lithuania) · 2026Review
- Coronary heart disease in young women: risk factors, mechanistic phenotypes, and implications for primary care.Frontiers in cardiovascular medicine · 2026Review
- Global burden and trend of ischemic heart disease and its attributable risk factors among women of childbearing age from 1990 to 2021.Frontiers in cardiovascular medicine · 2026Article
- A detailed review of pharmacokinetics/pharmacodynamics of progestogens in oral contraception.Frontiers in endocrinology · 2026Review
- Global, regional and national burden of stroke and subtypes burden in women of reproductive age: insights based on Global Burden of Disease 2021.BMC public health · 2025Article
- Spatiotemporal patterns and future trends of global ischemic stroke burden.Frontiers in neurologyArticle
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo evaluate the association between contemporary hormonal contraceptive use and the risk of incident ischaemic stroke and myocardial infarction.
designReal-world, nationwide, prospective cohort study.
settingDenmark, by use of national registries.
participantsAll women aged 15-49 years residing in Denmark between 1996 and 2021, with no history of arterial or venous thrombosis, antipsychotics use, cancer, thrombophilia, liver disease, kidney disease, polycystic ovary syndrome, endometriosis, infertility treatment, hormone therapy use, oophorectomy, and hysterectomy.
main outcome measuresFirst time diagnosis of ischaemic stroke or myocardial infarction at discharge.
resultsAmong 2 025 691 women followed up for 22 209 697 person years, 4730 ischaemic strokes and 2072 myocardial infarctions occurred. Standardised ischaemic stroke rate per 100 000 person years were 18 (95% confidence interval 18 to 19) for no use, 39 (36 to 42) for combined oral contraception, 33 (25 to 44) for progestin-only pills, and 23 (17 to 29) for intrauterine device. Standardised myocardial infarction rate per 100 000 person years were 8 (8 to 9) for no use, 18 (16 to 20) for combined oral contraception, 13 (8 to 19) for progestin-only pills, and 11 (7 to 16) for intrauterine device. Compared with no use, current use of combined oral contraception was associated with an adjusted rate ratio of 2.0 (1.9 to 2.2) for ischaemic stroke and 2.0 (1.7 to 2.2) for myocardial infarction. These corresponded to standardised rate differences of 21 (18 to 24) extra ischaemic strokes and 10 (7 to 12) extra myocardial infarctions per 100 000 person years. Compared with no use, current use of progestin-only pills was associated with an adjusted rate ratio of 1.6 (95% CI 1.3 to 2.0) for ischaemic stroke and 1.5 (1.1 to 2.1) for myocardial infarction, equating to 15 (6 to 24) extra ischaemic strokes and four (-1 to 9) extra myocardial infarctions per 100 000 person years. Increased arterial thrombotic risk was also observed with use of the combined vaginal ring (adjusted incidence rate ratio of 2.4 (1.5 to 3.7) for ischaemic stroke and 3.8 (2.0 to 7.3) for myocardial infarction), patch (3.4 (1.3 to 9.1) and no myocardial infarctions), and progestin-only implant (2.1 (1.2 to 3.8) and ≤3 myocardial infarctions), whereas no increased risk was observed with progestin-only intrauterine device (1.1 (1.0 to 1.3) for ischaemic stroke and 1.1 (0.9 to 1.3) for myocardial infarction).
conclusionsUse of contemporary oestrogen-progestin and progestin-only contraceptives was associated with an increased risk of ischaemic stroke and, in some cases, myocardial infarction except for the levonorgestrel-releasing intrauterine device, which was not associated with either. Although absolute risks were low, clinicians should include the potential risk of arterial thrombosis in their assessment of the benefits and risks when prescribing a hormonal contraceptive method.
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