Oral contraceptives: where are the excess deaths?

In the 1960s and 1970s a substantial body of data was published indicating an excess death rate, mainly related to a cluster of cardiovascular complications, in women who either were taking or had ever taken oral contraceptives. The epidemiological interpretation of these data has been seriously questioned, and many workers now think that the excess deaths in these women are almost entirely attributable to smoking. In addition, it is clear that the death rate from myocardial infarction in women in Australia, which has declined significantly in the last twelve years, is quite different from that seen in women in the United Kingdom, where the death rate from myocardial infarction continues to increases. The validity of basing warnings, contraindications and advice to patients regarding the use of oral contraceptives on data from different populations should be reconsidered.