Cardiovascular risks: Perception versus reality

The high estrogen doses in the original oral contraceptive (OC) formulation s were associated with an increased risk of cardiovascular events. Since th en the steroid doses in OC have been reduced steadily, so that current low- estrogen-dose (less than or equal to 35 mu g) combination OC are associated with a lower risk of arterial and venous events than occurs with higher-es trogen-dose formulations. Based on the currently available epidemiologic ev idence, the following conclusions can be made regarding the cardiovascular disease risks associated with use of low-dose OC by healthy, nonsmoking wom en: there is no increased risk of myocardial infarction (MI) or hemorrhagic or ischemic stroke; and there is a three- to fourfold increased risk of Ve nous thrombosis and embolism (VTE). This risk is about half that associated with pregnancy. Smoking is the most important independent risk factor for MI, and is synergistic with OC use. Women smokers should be advised strongl y to stop smoking, but those aged <35 years may use any OC containing less than or equal to 35 mu g of estrogen. Women smokers aged greater than or eq ual to 35 years should be advised to use a nonestrogen or nonhormonal contr aceptive method. CONTRACEPTION 1999;59: 21S-24S (C) 1999 Elsevier Science I nc. All rights reserved.