Dr. Gary Steinberg

had a very, very high incidence of developing clots and ischemic strokes and clots elsewhere in the body.

The newer generations are much safer in terms of developing clots.

But for my patients, many of whom have had strokes or are at risk for stroke,

We recommend that the women do not take oral contraceptives, that they use some other form.

IUD, for instance, may have a little bit of progesterone, which is released locally, but it doesn't cause a large increase in estrogens or progesterone systemically.

So, we still believe that the oral contraceptives increase the risk somewhat, not the way it did for first generation.

And then there are other modifiable factors besides the genetic ones.

So, smoking is a very high risk factor for developing clots, which can lead to strokes, heart attacks, peripheral vascular disease.

High lipids is another.

So when people have high, bad cholesterol LDL, it's recommended that if they can't reduce it with diet, that they take a statin.

The statins are very, very effective in lowering the bad cholesterol, preventing strokes and heart attack.

Interestingly,

The statins have also been shown to be highly beneficial for the blood vessel integrity, even if you don't have high LDL.

Interesting.

So they have other beneficial properties.

So again, for my patients, I often recommend they take a statin, even if they don't have high cholesterol.

And then hypertension is another risk factor for developing clots and arterial disease.

It's not just nicotine.

Nicotine is one of the factors, but it's the other products that are produced by smoking that can have an effect.

Yes, the incidence of stroke is actually decreasing.