Low-dose second-generation oral contraceptives are associated with the lowest increased risk of cardiovascular adverse effects.

Commentary on: Weill A, Dalichampt M, Raguideau F, et al. Low dose oestrogen combined oral contraception and risk of pulmonary embolism, stroke, and myocardial infarction in five million French women: cohort study. BMJ 2016;353:i2002.Oral contraceptives (OCs) are associated with an increased risk of cardiovascular disease. The association varies depending on whether the cardiovascular disease is arterial or venous and with varying progestogens and dosages of the oestrogen compound ethinyloestradiol. A recent Cochrane review concluded that OCs with the progestogens gestodene, desogestrel, cyproterone acetate or drospirenone are associated with 50–80% higher risk of venous thromboembolism compared to OCs with the progestogen compound levonorgestrel.1 Another study concluded that only OCs with ethinyloestradiol dosages of 50 µg or above are associated with increased risk of myocardial infarction and ischaemic stroke.2This observational cohort study analysed the …