Past oral contraceptive use and angiographic coronary artery disease in postmenopausal women: data from the National Heart, Lung, and Blood Institute–sponsored Women’s Ischemia Syndrome Evaluation

Objective

To evaluate past oral contraceptive use and angiographic coronary artery disease in women.

Setting

Academic medical centers.

Patient(s)

Six hundred seventy-two postmenopausal women enrolled in the Women’s Ischemia Syndrome Evaluation (WISE) with coronary risk factors undergoing coronary angiography for suspected myocardial ischemia.

Intervention(s)

Past oral contraceptive use, assessed by reproductive questionnaire.

Main Outcome Measure(s)

Quantitative coronary artery disease, assessed by a core angiography laboratory.

Result(s)

Past oral contraceptive use was associated with a lower mean coronary artery disease severity index score (mean ± SD: 11.8 ± 10.3 vs. 18.7 ± 17.3) compared with non–prior users, despite age adjustment. Past oral contraceptive use remained a significant independent negative predictor of coronary artery disease severity when adjusting for coronary risk factors, including age, diabetes mellitus, triglycerides, low-density lipoprotein cholesterol, smoking, aspirin use, and lipid-lowering medication (model R² = 0.19). The modeling indicated that past oral contraceptive use was associated with a 2.44 lower coronary artery disease severity score index. There was no apparent relationship between duration of past oral contraceptive use and the coronary artery disease severity index score.

Conclusion(s)

Past oral contraceptive use is associated with less coronary artery disease, measured by quantitative coronary angiography, among postmenopausal women with suspected myocardial ischemia. These findings suggest that a prospective study should address the hypothesis that past oral contraceptive use during the premenopausal years might offer women protection from atherosclerotic coronary disease later in life.

Key Words:  Oral contraceptives, coronary artery disease, postmenopausal, atherosclerosis