What are the risks of oral contraceptives in patients with cardiovascular disease risk factors?

Summary of ACOG recommendations concerning combination oral contraceptives and cardiovascular risk 2 Smoking Combination oral contraceptives should be prescribed with caution, if ever, to women who A are older than 35 years and are smokers. Diabetes The use of combination contraceptives by women with diabetes should be limited to such women who do B not smoke, are younger than 35 years, and are otherwise healthy with no evidence of hypertension, nephropathy, retinopathy, or other vascular disease. HTN Women with well-controlled and monitored hypertension who are aged ≤35 years are appropriate candidates B for a trial of combination contraceptives, provided they are otherwise healthy, show no evidence of end-organ vascular disease, and do not smoke. Hyperlipidemia Most women with controlled dyslipidemia can use combination oral contraceptives formulated C with ≤35 mcg estrogen. In women with uncontrolled LDL cholesterol >160 mg/dL, a triglyceride level >250 mg/dL, or multiple additional risk factors for coronary artery disease, alternative contraceptives should be considered. CAD, CHF, CVD Progestin-only contraceptives may be appropriate for women with coronary artery disease, C congestive heart failure, or cerebrovascular disease. However, combination contraceptives are contraindicated in these women.