Cardiovascular disease: Pathogenesis, epidemiology, and risk among users of oral contraceptives who smoke

Smoking increases the risk of lung cancer and cardiovascular disease among persons of both sexes; The risk of cardiovascular disease is further increa sed among users of oral contraceptives who smoke, particularly those who ar e greater than or equal to 35 years old or carry the coagulation factor V L eiden mutation. Other important cardiovascular disease risk factors in wome n include waist/hip girth ratio >0.8, high concentration of low-density lip oprotein cholesterol (>115 mg/dL), high triglyceride level (greater than or equal to 150 mg/dL) with low concentration of high-density lipoprotein cho lesterol (less than or equal to 45 mg/dL), high ratio of total cholesterol/ high-density lipoprotein (4.0), high ratio of low-density lipoprotein/high- density lipoprotein (3.0), glucose values greater than or equal to 100 mg/d L, hypertension, lack of physical activity, and high-fat diet. Most excess cardiovascular disease among users of oral contraceptives is due to thrombo sis (not atherosclerosis); studies indicate that the lower the oral contrac eptive estrogen dose is, the lower is this risk. Oral contraceptives contai ning the third-generation progestins desogestrel and gestodene have been as sociated with greater risks of Venous thromboembolism than are associated w ith older progestins, although there is some controversy surrounding these findings.