MODERN ORAL-CONTRACEPTIVES AND CARDIOVASCULAR-DISEASE

We reviewed evidence that bears on the cardiovascular safety of combin ed oral contraceptives containing second-and third-generation progesto gens and <50 mu g of estrogen. Recent epidemiologic studies indicate t hat current use of these formulations is associated with a smaller inc rease in the incidence of Venous thromboembolism than earlier formulat ions. In some studies the increase for third-generation formulations c ontaining desogestrel or gestodene was about 1.5 to 2 times that for s econd-generation formulations, but there is evidence that differences between users in underlying risk and likelihood of being diagnosed con tributed to this result. Recent studies of myocardial infarction sugge st a smaller increase in risk associated with modern formulations than with earlier ones; one study suggests a threefold increase for second -generation formulations and no increase for third-generation formulat ions, but the finding requires confirmation. Recent studies of stroke indicate little or no increase in risk for modern formulations among w omen without risk factors. We conclude that modern combined oral contr aceptives are safer than earlier formulations with respect to cardiova scular disease, which occurs rarely in young women.