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dc.contributor.authorPoulter, N. R.
dc.contributor.authorChang, C. L.
dc.contributor.authorFarley, TMM
dc.contributor.authorMeirik, O.
dc.contributor.authorMarmot, Michael Gideon
dc.contributor.authorDebert-Ribeiro, Myriam [UNIFESP]
dc.contributor.authorMedina, Ernesto
dc.contributor.authorArtigas, Jorge
dc.contributor.authorShen, He
dc.contributor.authorZhong, Yu Hui
dc.contributor.authorZhang, De Wei
dc.contributor.authorZhao, Wei Jin
dc.contributor.authorRojas, Oscar
dc.contributor.authorVessey, Martin
dc.contributor.authorHeinemann, Lothar
dc.contributor.authorDonnan, Stuart
dc.contributor.authorHo, Suzanne
dc.contributor.authorBartfai, Gyorgy
dc.contributor.authorKisjanto, J.
dc.contributor.authorWilks, Rainford
dc.contributor.authorAgwanda, Reuben
dc.contributor.authorRuiz, Rossario
dc.contributor.authorKozuh-Novak, Mateja
dc.contributor.authorDusitsin, Nikorn
dc.contributor.authorVirutamasen, Pramuan
dc.contributor.authorPhanthumcinda, Kammant
dc.contributor.authorKoetsawang, Suporn
dc.contributor.authorPiya-Anant, Manee
dc.contributor.authorDemirovic, Jasenka
dc.contributor.authorBelkic, Karen
dc.contributor.authorMwandila, W. S.
dc.contributor.authorMutale, C. M.
dc.contributor.authorMatenga, Jonathon
dc.contributor.authorWilson, Adrian
dc.contributor.authorPetitti, D.
dc.contributor.authorPerlman, J.
dc.contributor.authorKeleghan, J.
dc.contributor.authorLawley, S.
dc.contributor.authorSmith, S.
dc.contributor.authorShipley, M.
dc.contributor.authorOlsen, J.
dc.contributor.authorThorogood, M.
dc.date.accessioned2018-06-18T10:54:42Z
dc.date.available2018-06-18T10:54:42Z
dc.date.issued1996-08-24
dc.identifierhttp://dx.doi.org/10.1016/S0140-6736(95)12393-8
dc.identifier.citationLancet. New York: Elsevier Science Inc, v. 348, n. 9026, p. 498-505, 1996.
dc.identifier.issn0140-6736
dc.identifier.urihttp://repositorio.unifesp.br/11600/44829
dc.description.abstractBackground 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.en
dc.format.extent498-505
dc.language.isoeng
dc.publisherElsevier B.V.
dc.relation.ispartofLancet
dc.rightsAcesso restrito
dc.titleIschaemic stroke and combined oral contraceptives: Results of an international, multicentre, case-control studyen
dc.typeArtigo
dc.rights.licensehttp://www.elsevier.com/about/open-access/open-access-policies/article-posting-policy
dc.contributor.institutionWHO
dc.contributor.institutionUniversidade Federal de São Paulo (UNIFESP)
dc.contributor.institutionUNIV CHILE
dc.contributor.institutionESCUELA MED
dc.contributor.institutionNATL RES INST FAMILY PLANNING
dc.contributor.institutionSICHUAN FAMILY PLANNING RES INST
dc.contributor.institutionSHANGHAI INST PLANNED PARENTHOOD RES
dc.contributor.institutionUNIV VALLE
dc.contributor.institutionUNIV OXFORD
dc.contributor.institutionZENTRUM EPIDEMIOL & GESUNDHEITSFORSCH
dc.contributor.institutionCHINESE UNIV HONG KONG
dc.contributor.institutionALBERT SZENT GYORGYI MED UNIV
dc.contributor.institutionUNIV INDONESIA
dc.contributor.institutionUNIV W INDIES
dc.contributor.institutionKENYA GOVT MED RES CTR
dc.contributor.institutionGRP INTERUNIV MEXICANO INVEST EPIDEMIOL SALUD REP
dc.contributor.institutionUNIV LJUBLJANA
dc.contributor.institutionCHULALONGKORN HOSP
dc.contributor.institutionSIRIRAJ HOSP
dc.contributor.institutionUNIV BELGRADE
dc.contributor.institutionUNIV LUSAKA
dc.contributor.institutionUNIV ZIMBABWE
dc.contributor.institutionUCL
dc.contributor.institutionKAISER PERMANENTE
dc.contributor.institutionNIH
dc.contributor.institutionUNIV AARHUS
dc.contributor.institutionUNIV LONDON LONDON SCH HYG & TROP MED
dc.description.affiliationWHO, UNDP UNFPA WHO WORLD BANK SPECIAL PROGRAMME RES D, CH-1211 GENEVA 27, SWITZERLAND
dc.description.affiliationESCOLA PAULISTA MED, DEPT PREVENT MED, SAO PAULO, BRAZIL
dc.description.affiliationUNIV CHILE, ESCUELA SALUD PUBL, SANTIAGO, CHILE
dc.description.affiliationESCUELA MED, DEPT SALUD PUBL, VALPARAISO, CHILE
dc.description.affiliationNATL RES INST FAMILY PLANNING, BEIJING, PEOPLES R CHINA
dc.description.affiliationSICHUAN FAMILY PLANNING RES INST, CHENGDU, PEOPLES R CHINA
dc.description.affiliationSHANGHAI INST PLANNED PARENTHOOD RES, SHANGHAI, PEOPLES R CHINA
dc.description.affiliationUNIV VALLE, FAC SALUD, CALI, COLOMBIA
dc.description.affiliationUNIV OXFORD, DEPT PUBL HLTH & PRIMARY CARE, OXFORD OX3 7LF, ENGLAND
dc.description.affiliationZENTRUM EPIDEMIOL & GESUNDHEITSFORSCH, BERLIN, GERMANY
dc.description.affiliationCHINESE UNIV HONG KONG, DEPT COMMUNITY MED, HONG KONG, HONG KONG
dc.description.affiliationALBERT SZENT GYORGYI MED UNIV, DEPT OBSTET & GYNAECOL, SZEGED, HUNGARY
dc.description.affiliationUNIV INDONESIA, FAC MED, JAKARTA, INDONESIA
dc.description.affiliationUNIV W INDIES, TROP METAB RES UNIT, KINGSTON 7, JAMAICA
dc.description.affiliationKENYA GOVT MED RES CTR, NAIROBI, KENYA
dc.description.affiliationGRP INTERUNIV MEXICANO INVEST EPIDEMIOL SALUD REP, DURANGO, MEXICO
dc.description.affiliationUNIV LJUBLJANA, INST PUBL HLTH, LJUBLJANA, SLOVENIA
dc.description.affiliationCHULALONGKORN HOSP, DEPT OBSTET & GYNAECOL, BANGKOK, THAILAND
dc.description.affiliationSIRIRAJ HOSP, SIRIRAJ FAMILY HLTH RES CTR, BANGKOK, THAILAND
dc.description.affiliationUNIV BELGRADE, SCH MED, BELGRADE, YUGOSLAVIA
dc.description.affiliationUNIV LUSAKA, TEACHING HOSP, LUSAKA, ZAMBIA
dc.description.affiliationUNIV ZIMBABWE, DEPT MED, HARARE, ZIMBABWE
dc.description.affiliationUCL, LONDON MED SCH, DEPT EPIDEMIOL & PUBL HLTH, LONDON, ENGLAND
dc.description.affiliationKAISER PERMANENTE, PASADENA, CA USA
dc.description.affiliationNIH, BETHESDA, MD 20892 USA
dc.description.affiliationUNIV AARHUS, DANISH EPIDEMIOL SCI CTR, AARHUS, DENMARK
dc.description.affiliationUNIV LONDON LONDON SCH HYG & TROP MED, LONDON WC1E 7HT, ENGLAND
dc.description.affiliationUnifespESCOLA PAULISTA MED, DEPT PREVENT MED, SAO PAULO, BRAZIL
dc.identifier.doi10.1016/S0140-6736(95)12393-8
dc.description.sourceWeb of Science
dc.identifier.wosWOS:A1996VD42700009


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