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Smoking, Oral Contraceptives, Noncontraceptive Estrogens, and Other Factors

Diana B. Petitti, MD; John Wingerd, MA; Frederick Pellegrin, MD; Savitri Ramcharan, MD, PhD

JAMA. 1979;242(11):1150-1154.

Abstract
We investigated the relation in women of various factors to risk of myocardial infarction, subarachnoid hemorrhage, other strokes, and venous thromboembolism. Smoking significantly increased risk of all four diseases, whereas oral contraceptive use was associated with an increase only in risk of subarachnoid hemorrhage and venous thromboembolism. Use of noncontraceptive estrogens was not associated with increased risk of any of these diseases. Hypertension, hypercholesterolemia, obesity, gallbladder disease, and nondrinking of alcohol were all associated with increased risk of myocardial infarction, whereas only hypertension and hypercholesterolemia were associated with increased risk of other strokes. Cigarette smoking was overwhelmingly the most important risk factor for vascular disease in women. Smoking should be considered a contraindication to oral contraceptive use, or at the very least, women wishing to use oral contraceptives should be strongly urged not to smoke.

(JAMA 242:1150-1154, 1979)

Author Affiliations
From Family Planning Evaluation Division, Bureau of Epidemiology, Center for Disease Control, Atlanta (Dr Petitti), and the Kaiser-Permanente Contraceptive Drug Study, Walnut Creek, Calif.

Footnotes
Reprint requests to Contraceptive Drug Study, Kaiser-Permanente Medical Center, 1425 S Main St, Walnut Creek, CA 94596 (Dr Ramcharan).

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