New and "safer" forms still present risks.

• Position: Female Contraception

Introduced in the 1960s, oral contraceptives have been used by about 80% of women in the U.S. at some point in their lives. For those without pre-existing risks for heart disease, the early formulations generally were safe, and the newer ones appear to be even mere so, but all the risks and benefits are yet to be established, especially as women's lifestyles change and new forms of contraceptives become available, according to in female heart disease specialists at Cedars-Sinai Medical Center, Los Angeles.

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"As women use these therapies more frequently and for longer periods of time, there is an urgent need to better understand and minimize associated cardiovascular risks," advises C. Noel Bairey-Merz, director of the Women's Heart Center and the Preventive and Rehabilitative Cardiac Center.

Reproductive hormones affect the tone and function of blood vessels as well as lipid (fat) levels in the blood. Low estrogen levels have been found to increase risk of coronary atherosclerosis (thickening and hardening of artery walls) and adverse cardiac events, such as heart attacks and strokes, but the use of supplemental estrogen in hormone replacement therapy has been linked to an elevated risk of blood clots that can lead to heart attacks and strokes.

"Health care providers must evaluate each woman's risk factors, especially those related to cardiovascular health, prior to starting any contraceptive therapy. Although pre-menopausal women have a much lower risk of cardiovascular disease, routine screening for potential problems and follow-up is important," points out Chrisandra L. Shufelt, assistant director of the Women's Heart Center.

The...