Rochester, NY: The use of progestin-only oral contraceptive (OC) is associated with increased cardiovascular risk in women with inherited long QT syndrome (LQTS) and should not be administered in this women population without concomitant beta-blocker therapy, showed a recent study.
The findings, published in the journal Heart Rhythm, imply that OC should be used with caution in women with long QT syndrome (LQTS).
Ilan Goldenberg, University of Rochester Medical Center, Rochester, NY, and colleagues aimed to evaluate the association of OC with the risk of cardiac events (CE) in long QT syndrome (LQTS) women.
For this purpose, the researchers obtained information on menarche onset, OC use, pregnancy, and menopause from women enrolled in the Rochester LQTS Registry. OC types were as follows -- Progestin-only, Estrogen-only or Combined (Estrogen/Progestin).
The association of time-dependent OC use with the burden of CE (total number of syncope, aborted cardiac arrest, and LQTS-related sudden cardiac death) from menarche onset through 40 years were evaluated using Andersen-Gill multivariate modeling. Findings were adjusted for genotype, QTc duration, and time-dependent beta-blocker therapy.
A total of 1659 LQTS women followed through March 2021, of whom 370 (22%) were treated with an OC.
Key findings of the study include:
During a cumulative follow-up of 35,797 years, there were a total of 2,027 CE.
Multivariate analysis showed that Progestin-only OC was associated with a pronounced 2.8-fold increased risk of CE among women who did not receive beta-blocker therapy, while beta-blockers were highly protective during Progestin-only OC treatment (HR=0.22); p-value for beta-blocker-by-OC interaction = 0.006).
The risk associated with OC use without concomitant beta-blocker treatment was pronounced in LQT2 women.
"Our findings suggest that Progestin-only OC should not be administered in long QT syndrome (LQTS) women without concomitant beta-blocker therapy. OC should be used with caution in long QT syndrome (LQTS) women," concluded the authors.
Reference:
The study titled, "Use of Oral Contraceptives in Women with Congenital Long QT Syndrome," is published in the journal Heart Rhythm.
DOI: https://www.heartrhythmjournal.com/article/S1547-5271(21)01987-1/fulltext