Ischaemic stroke and combined oral contraceptives: Results of an international, multicentre, case-control study

Ischaemic stroke and combined oral contraceptives: Results of an international, multicentre, case-control study

Author Poulter, N. R. Google Scholar
Chang, C. L. Google Scholar
Farley, TMM Google Scholar
Meirik, O. Google Scholar
Marmot, Michael Gideon Google Scholar
Debert-Ribeiro, Myriam Autor UNIFESP Google Scholar
Medina, Ernesto Google Scholar
Artigas, Jorge Google Scholar
Shen, He Google Scholar
Zhong, Yu Hui Google Scholar
Zhang, De Wei Google Scholar
Zhao, Wei Jin Google Scholar
Rojas, Oscar Google Scholar
Vessey, Martin Google Scholar
Heinemann, Lothar Google Scholar
Donnan, Stuart Google Scholar
Ho, Suzanne Google Scholar
Bartfai, Gyorgy Google Scholar
Kisjanto, J. Google Scholar
Wilks, Rainford Google Scholar
Agwanda, Reuben Google Scholar
Ruiz, Rossario Google Scholar
Kozuh-Novak, Mateja Google Scholar
Dusitsin, Nikorn Google Scholar
Virutamasen, Pramuan Google Scholar
Phanthumcinda, Kammant Google Scholar
Koetsawang, Suporn Google Scholar
Piya-Anant, Manee Google Scholar
Demirovic, Jasenka Google Scholar
Belkic, Karen Google Scholar
Mwandila, W. S. Google Scholar
Mutale, C. M. Google Scholar
Matenga, Jonathon Google Scholar
Wilson, Adrian Google Scholar
Petitti, D. Google Scholar
Perlman, J. Google Scholar
Keleghan, J. Google Scholar
Lawley, S. Google Scholar
Smith, S. Google Scholar
Shipley, M. Google Scholar
Olsen, J. Google Scholar
Thorogood, M. Google Scholar
Institution WHO
Universidade Federal de São Paulo (UNIFESP)
UNIV CHILE
ESCUELA MED
NATL RES INST FAMILY PLANNING
SICHUAN FAMILY PLANNING RES INST
SHANGHAI INST PLANNED PARENTHOOD RES
UNIV VALLE
UNIV OXFORD
ZENTRUM EPIDEMIOL & GESUNDHEITSFORSCH
CHINESE UNIV HONG KONG
ALBERT SZENT GYORGYI MED UNIV
UNIV INDONESIA
UNIV W INDIES
KENYA GOVT MED RES CTR
GRP INTERUNIV MEXICANO INVEST EPIDEMIOL SALUD REP
UNIV LJUBLJANA
CHULALONGKORN HOSP
SIRIRAJ HOSP
UNIV BELGRADE
UNIV LUSAKA
UNIV ZIMBABWE
UCL
KAISER PERMANENTE
NIH
UNIV AARHUS
UNIV LONDON LONDON SCH HYG & TROP MED
Abstract Background The association between use of oral contraceptives (OCs) and cerebral infarction was established in studies from northern Europe and the USA during the 1960s and 1970s. Since then, the constituents of hormonal OCs have changed and now contain lower doses of oestrogen and progestagen. Current recommendations restrict OC use to younger women who do not have other risk factors for cardiovascular disease, in this international study we assessed the risk of CC-associated first stroke in women from Europe and other countries throughout Vie world.Methods In this hospital-based, case-control study, we assessed the risk of ischaemic stroke in association with current use of combined OCs in 697 cases, aged 20-44 years, and 1962 age-matched hospital controls in 21 centres in Africa, Asia, Europe, and Latin America. The diagnosis of ischaemic stroke was almost exclusively based on computed tomography (CT), magnetic resonance imaging (MRI), or cerebral angiography carried out within 3 weeks of the clinical event. Ail cases and controls were interviewed while in hospital with the same questionnaire, which included information on medical and personal history, details of lifetime contraceptive use, and blood-pressure measurements before the most recent episode of OC use.Findings The overall odds ratio of ischaemic stroke was 2 . 99 (95% CI 1 . 65-5 . 40) in Europe and 2 . 93 (2 . 15-4 . 00) in the non-European (developing) countries, Odds ratios were lower in younger women and those who did not smoke, and less than 2 in women who did not have hypertension and who reported that their blood pressure had been checked before the current episode of OC use. By contrast, among current OC users with a history of hypertension, the odds ratio was 10 . 7 (2 . 04-56 . 6) in Europe and 14 . 5 (5 . 36-39 . 0) in the developing countries. In Europe, the odds ratio associated with current use of low-dose OCs (<50 mu g oestrogen) was 1 . 53 (0 . 71-3 . 31), whereas for higher-dose preparations it was 5 . 30 (2 . 56-11 . 0). In the developing countries, there was no significant difference between overall estimates of risk associated with use of low-dose or higher-dose OCs (3 . 26 [2 . 19-4 . 86] vs 2 . 71 [1 . 75-4 . 19]), This differential effect of dose in Europe and the developing countries is likely to be due to different levels of other risk factors among users of low-dose and higher-dose OCs in the two groups of countries. There was no significant increase in odds ratios with increasing duration of OC use among current users; odds ratios were not significantly increased after cessation of OC use.Interpretation The incidence of ischaemic stroke is low in women of reproductive age and any risk attributable to OC use is small. The risk can be further reduced if users are younger than 35 years, do not smoke, do not have a history of hypertension, and have blood pressure measured before the start of QC use. In such women OC preparations with low oestrogen doses may be associated with even lower risk.
Language English
Date 1996-08-24
Published in Lancet. New York: Elsevier Science Inc, v. 348, n. 9026, p. 498-505, 1996.
ISSN 0140-6736 (Sherpa/Romeo, impact factor)
Publisher Elsevier B.V.
Extent 498-505
Origin http://dx.doi.org/10.1016/S0140-6736(95)12393-8
Access rights Closed access
Type Article
Web of Science ID WOS:A1996VD42700009
URI http://repositorio.unifesp.br/11600/44829

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