Emerging evidence on oral contraceptives and arterial disease

A number of case-control studies published in recent years have shown an ap parent increase in the risk of venous thromboembolism (VTE) associated with the use of third-generation oral contraceptives (OCs) compared with second -generation OCs. However, it is thought that these studies were subject to a number of biases that would have increased the risk estimates for third-g eneration OCs while lowering those for second-generation preparations. Data on the risk of ischemic stroke and myocardial infarction (MI) show no such difference between generations of OCs, with a statistically significant re duction in the risk of acute MI from first- to third-generation in one majo r study. Available results indicate that there is no significant increase i n the risk of ischemic stroke or acute MI associated with the use of low-do se estrogen OCs in young women who are properly screened before use, and wh o have no pre-existing cardiovascular risk factors, such as smoking and hyp ertension, for these conditions. These findings should be taken into accoun t when interpreting the results of studies on the risk of VTE in women taki ng combined OCs. (C) 2000 Elsevier Science Inc. All rights reserved.