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Oral Contraceptive Use and Risk of Death Restricted to Smokers

Use of oral contraceptives (OCs) has no adverse effect on overall mortality, but heavy smokers who use Ocs have a more than two-fold higher risk of death from ischaemic heart disease, a large study of 17,032 women reported recently.

Martin Vessey, MD, emeritus professor of public health, University of Oxford, United Kingdom, and colleagues analysed 889 deaths that occurred over 30 years in women enrolled in the Oxford Family Planning Association (Oxford FPA) study. The women were either never users of OCs or were users for more than 8 years.

For all causes of mortality, the rate ratio for death was 0.89 for OC users overall. For the subgroup of women who smoked 14 cigarettes or fewer per day, the rate ratio was 1.24, and for those who smoked 15 or more cigarettes per day, the rate ratio for death was 2.14.

There was no increased risk of death from breast cancer among OC users, Dr. Vessey and colleagues note. "Indeed, our results suggest the reverse," they state. On the other hand, smokers had more than double the risk of death from ischaemic heart disease.

"The effect of heavy smoking in our study is large, and [is] similar to that reported by others. Our results suggest that the risk associated with oral contraceptive use is confined to smokers, which is consistent with most other work."

Dr. Vessey notes that the average dose of oestrogen among these users of OCs in this long-term study was 50 mcg, "a high dose by current standards."

He points out that, while the findings of this study cannot be applied to users of the current low-dose formulations, "they do nonetheless offer considerable encouragement."
Lancet 2003;362:185-191.

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