RESUMO
PIP: Data on 146 Mexican women aged 20-44 years who were residents of the Mexico City metropolitan area, married or in stable union, and who suffered from nonrheumatic cardiovascular disease, and on 387 controls matched for age, parity, and education were used to study the possible association of nonrheumatic cardiovascular diseases and the use of oral contraceptives (OCs). The women were hospitalized at Mexican Institute of Social Security hospitals between 1979 and 1982. 20 cases had ischemic heart disease, 15 had cerebrovascular accidents, 50 had pulmonary embolism or venous thrombosis, 27 had hypertensive cardiopathy, and 41 had other conditions, primarily arrhythmia, cardiomyopathies, and pericarditis. Among OC users and controls respectively, 1.3% and 2.3% had never been pregnant. 35.0% and 18.6% were aged 20-29 years, 50.0% and 49.0% were 30-39, and 15.0% and 32.4% were 40-44. 25.0% of users and 22.8% of nonusers currently smoked. 60.0% of users and 76.5% of nonusers had primary education or less. The relative risk for nonrheumatic cardiovascular disease was 1.00 for 58 women who had never used OCs, 1.49 for 88 ever-users of OCs, and 1.40 for 26 current users. The relative risk for 10 women using pills with an estrogen dose of 40 mcg or less was 1.60, compared to 1.06 for 11 women with an estrogen dose over 40 mcg. The relative risk was 1.60 for 52 patients using OCs for 12 months or less, 1.13 for 22 patients using them for 13-48 months, and 1.87 for 14 patients using them for over 48 months. Relative risk increased by age and was over 3 times as high for women aged 40-44. The relative risk was 1.55 for 13 OC users who had never smoked, .44 for 2 users who had previously smoked, and 1.51 for 11 users who currently smoked. Considering smoking only, relative risk was 1.00 for 80 women who never smoked, 1.61 for 66 who previously smoked, and 1.45 for 47 who currently smoked. The risk was significantly increased in OC users for ischemic heart disease, cerebrovascular accidents, venous thrombosis, and pulmonary thromboembolism.^ieng
Assuntos
Doenças Cardiovasculares/induzido quimicamente , Anticoncepcionais Orais/efeitos adversos , Adulto , Doenças Cardiovasculares/epidemiologia , Feminino , Humanos , México , Estudos Retrospectivos , FumarRESUMO
PIP: After 20 years of clinical experience, injectable hormonal contraceptives such as norethisterone enanthate (NET) and medroxyprogesterone acetate (MPA) remain one of the most controversial methods currently used for temporary control of fertility in women. Since December 1980 this controversy has been accentuated in Mexico with issuing of regulations by the Secretary of Health and Welfare which initially did not permit promotion of long-acting injectable hormones for contraception purposes, and later, in June 1981, a reconsideration which exclusively authorized use of NET as an injectable contraceptive. Undeniably these official measures and the scientific information, occasionally contradictory, have created confusion about the indications and risks of using these formulations in clinical work. This paper presents an anlysis of the basic pharmacological aspects of long-acting contraceptive progestagens, potential risks for side effects, and some clinical rules for safe use. The authors conclude that injectable contraceptives will continue holding a definite place among hormonal methods of temporary fertility control, particularly with the advent of new administration schemes for NET which have elevated its contraceptive efficacy without appreciably increasing complications. The more rapid metabolism of NET, manifested in the absence of significant effects on body weight, less alteration of the menstrual cycle, and more rapid return of fertility after discontinuation, has considerably increased its popularity, and the possibility exists that with time and an increase in clinical experience, it may replace MPA as the injectable contraceptive of choice. Nevertheless, while investigative studies have not clearly defined the possibilities of potential risk of using these contraceptives, its clinical use must be governed by appropriate selection and careful follow-up of patients.^ieng