Introduction: Women's cardiovascular risk is not adequately addressed, particularly during the menopausal transition when the risk of cardiovascular events rises. Women die from cardiovascular disease (CVD) more frequently than any other cause. The study's objective was to evaluate pre-menopausal women's heart disease risk in connection to oral contraceptive tablets. Method: A comparative observational study was conducted at the department of cardiology, Prime Medical College Hospital, Rangpur, Bangladesh during the period of January 2020 to December 2020. A total of 140 participants were included for the study. Among them 70 women with HD (Heart Disease) were Group I and 70 women without HD (Heart Disease) were Group II. Respectively women were assessed exclusively using a case sheet that include age, full medical history, past medical history (mainly hypertension), family history, smoking history & the use of oral contraceptive pill (OCP) and duration of use. Statistical analyses were done by using SPSS 19.0 for windows Inc. Results: Mean age was 45.97 ±0.46 women with HD and 44.83 ±0.57 was women without HD. Women with HD age range 50-55 were 82.9 % (58) and 81.4% (57) were women without HD. Overweight & Obese were 66(94.3%) women with HD and 50(71.4%) were women without HD. Dyslipidemia were 69(98.6%) women with HD and 16(22.9%) were women without HD. Hypertension 65(92.8%)were women with HD and 16(22.9%) were women without HD. Use of OCP was higher among women with HD 61(87.1%) as compared with those without HD 29(41.4%). Duration of OCP was significantly longer in women with HD than women without HD. The effect of OCP use in women with Hypertension 40(61.33%) were women with HD and 6 (37.50%)were women without HD. The effect of OCP use in women with Smoking 10 (68.42%)were women with HD and 1 (25%)were women without HD. The effect of OCP use in women with Family history 34 (57.14%)were women with HD and 6 (33.33%)were women without HD. This study has confirmed the aforesaid findings in which the use of OCP increase the risk of HD in premenopausal women specifically in those who already have risk factors of HD. The effect of OCP use in women with Hypertension 51(61.5%) were women with HD and 6 (35.8%) were women without HD. Conclusion: The risk of heart disease was increased among women who used oral contraceptives. Cardiovascular events can be abridged by the management of risk factors. Mainly significant is the control of hypertension, lipids, and other factors contributing to the metabolic syndrome.