Most epidemiologic studies suggest an association between current use of combined oral contraceptives and certain manifestations of cardiovascular disease. Most of the data relate to older preparations little used today. Decreased levels of high-density lipoprotein cholesterol and increased amounts of low-density lipoprotein cholesterol were common findings with the older formulations. More recent experimental and epidemiologic data suggest that the potential risk of cardiovascular disease in oral contraceptive users is hardly predicated on an arteriosclerosis basis but related more to thromboembolic events. Because changes in the serum lipid profile are often associated with alterations in the factors of hemostasis, it seems reasonable to suggest the use of preparations void of profound changes in lipid metabolism, especially when other means of efficacy are available inclusive of the newer low-dose oral contraceptives. When risk factors for cardiovascular disease are present, determination of total cholesterol is desirable. In subjects with elevated serum cholesterol, a serum lipid profile should be determined. A woman at risk of cardiovascular disease should be carefully monitored, and repeated lipid determinations are recommended.