Oral Contraceptives and Cardiovascular Disease: Emerging Evidence on Potential Associations with Angina, Myocardial Infarction and Stroke

Associations between combined estrogen/progestin oral contraceptives (OCs) and cardiovascular disease (CVD) have long been the focus of considerable concern. Initial, epidemiologic studies demonstrated increased risks of potential complications including deep venous thrombosis/pulmonary embolism, myocardial infarction and stroke. While the studies regarding venous thromboembolism consistently demonstrate at least some degree of risk associated with OC use, recent studies of both current and past OC users indicate that the association with arterial disease is dynamic, changing rapidly as OC formulations and OC-user populations change. As physicians increase selection, screening and monitoring of OC users, a healthier OC-user population is developing. Thus, many newer studies are demonstrating rates of angina and myocardial infarction that are either lower or the same as that of non-users, unless pre-existing risk factors are present leading to potential increases in risk of CVD. The evidence with regards to strokes is more complicated and controversial. While further study is necessary, current evidence suggests that OC use provides significant contraceptive benefits with minimal potential adverse effects in healthy users. The potential for CVD reduction in selected OC users merits the highest priority for further investigation.