A troubling study from Belgium
hints that long-term use of oral contraceptives
at least the high-estrogen ones sold decades ago
might increase the chances of having artery buildups that
can raise the risk of heart disease.
The theory needs much more rigorous testing than this
single small study, but is important because of the sheer
number of women now taking the pill 100 million
"I don't think this should be a cause for alarm among
women," because many previous studies have found no large
increase in heart attacks among pill users, said Dr. JoAnn
Manson, chief of preventive medicine at Harvard-affiliated
Brigham and Women's Hospital in Boston.
She had no role in the new study, which was presented
Tuesday at an American
Heart Association conference in Florida.
About 16 million American women currently take birth
control pills and hundreds of millions have used
them since they were first sold in 1960. Most combine
synthetic estrogen and progestin in various doses.
They already are known to carry a small risk of blood
clots and high blood pressure for women currently taking
them, and any additional heart attack or stroke risk is
thought to be related to those two effects, Manson said.
Researchers at the University of Ghent in Belgium decided
to look for other signs of heart risks among past and
current pill users. They studied about 1,300 healthy women
ages 35 to 55 taking part in a long-running observational
study in the small town of Erpe-Mere.
About 81 percent had taken oral contraceptives for more
than a year at some point in their lives similar
to the prevalence the federal Centers for Disease Control
and Prevention reports for American women ages 15 to 44,
said the study's leader, Dr. Ernst Rietzschel. About 27
percent were current users.
Ultrasound exams were done of arteries in their necks
and legs to look for buildups called plaque. There was
a 20 to 30 percent increased prevalence of plaque for
every 10 years of oral contraceptive use.
"These are small plaques," not nearly large enough to
block an artery, Rietzschel said.
However, any plaque is thought to raise the risk of heart
Researchers concede they have no information on whether
the presence of plaque translated to any true risk of
heart attacks or strokes in the group.
Many in the study had taken first-generation birth
control pills, which had twice the estrogen levels
in most ones sold today.
Doses and ages of pill use could matter, but the Belgium
researchers do not have enough detail on this to tell,
said Dr. Daniel Jones, a University of Mississippi cardiologist
and president of the Heart Association.
"It could be an important study," but the finding needs
to be tested in larger and more rigorous studies in which
one group of women are given pills, another are not, and
their health is closely watched for some time afterward,
Rietzschel agreed, but said: "It's incredible that a
drug which has been taken by 80 percent of women ... is
almost bereft of any long-term outcome data, safety data."
Women worried about heart risks should not abandon birth
control pills but should follow guidelines for their use
and avoid other things that raise heart risks, like smoking,
being overweight, and not exercising, Rietzschel said.