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

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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.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.institutionKAISER PERMANENTE
dc.contributor.institutionNIH
dc.contributor.institutionUNIV AARHUS
dc.contributor.institutionUNIV LONDON LONDON SCH HYG & TROP MED
dc.date.accessioned2018-06-18T10:54:43Z
dc.date.available2018-06-18T10:54:43Z
dc.date.issued1996-08-24
dc.description.abstractBackground The risk of haemorrhagic stroke associated with use of oral contraceptives (OCs) is less well-established than that for ischaemic stroke. We assessed the risk of haemorrhagic stroke associated with current use of modern OCs as now used throughout the world.Methods In this WHO collaborative, case-control study, we assessed the association between risk of haemorrhagic stroke and use of combined OCs in 1068 cases, 20-44 years, and 2910 age-matched controls. We also assessed risks for all strokes combined (haemorrhagic, ischaemic, and unclassified) based on 2198 cases and 6086 controls.Findings Overall, current use of combined OCs was associated with slightly increased risk of haemorrhagic stroke; the increase was significant in the developing countries (odds ratio 1 . 76 [95% CI 1 . 34-2 . 30]) but not in Europe (1 . 38 [0 . 84-2 . 25]). Use of OCs in women younger than 35 years did not affect risk of haemorrhagic stroke in either group of countries, whereas in women aged older than 35 years, odds ratios were greater than 2. Women who were current users of OCs and had a history of hypertension (detected before current episode of OC use, but not during pregnancy) had a substantially increased risk (ten-fold to 15-fold) of haemorrhagic stroke compared with women who did not use OCs and had no history of hypertension. Odds ratios among current OC users who were also current cigarette smokers were greater than 3. In both groups of countries, past use of OCs, dose of oestrogen, and dose and type of progestagen had no effect on risk, and risks were similar for subarachnoid and intracerebral haemorrhage.The odds ratios for any type of stroke associated with current use of low-dose (<50 mu g oestrogen) and higher-dose OCs were 1 . 41 (0 . 90-2 . 20) and 2 . 71 (1 . 70-4 . 32), respectively, in Europe and 1 . 86 (1 . 49-2 . 33) and 1 . 92 (1 . 48-2 . 50) in the developing countries. From these data we estimated that about 13% and 8% of all strokes in women aged 20-44 in Europe and the developing countries, respectively, are attributable to the use of OCs.Interpretation The risk of haemorrhagic stroke attributable to OC use is not increased in younger women and is only slightly increased in older women. The estimated excess risk of all stroke types associated with use of low-oestrogen and higher-oestrogen dose OCs in Europe was about two and eight, respectively, per 100 000 woman-years of OC use. However, findings need to be considered in the context of other risks and benefits associated with OC use, as well as those associated with the use of other forms of contraception.en
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, H-6701 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.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.description.sourceWeb of Science
dc.format.extent505-510
dc.identifierhttp://dx.doi.org/10.1016/S0140-6736(95)12394-6
dc.identifier.citationLancet. New York: Elsevier Science Inc, v. 348, n. 9026, p. 505-510, 1996.
dc.identifier.doi10.1016/S0140-6736(95)12394-6
dc.identifier.issn0140-6736
dc.identifier.urihttp://repositorio.unifesp.br/handle/11600/44830
dc.identifier.wosWOS:A1996VD42700010
dc.language.isoeng
dc.publisherElsevier B.V.
dc.relation.ispartofLancet
dc.rightsAcesso restrito
dc.rights.licensehttp://www.elsevier.com/about/open-access/open-access-policies/article-posting-policy
dc.titleHaemorrhagic stroke, overall stroke risk, and combined oral contraceptives: Results of an international, multicentre, case-control studyen
dc.typeArtigo
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