Stroke and Use of Low-Dose Oral Contraceptives in Young Women A Pooled Analysis of Two US Studies

• Published in: Stroke (1970) Vol. 29; no. 11; pp. 2277 - 2284
• Main Authors: Schwartz, Stephen M., Petitti, Diana B., Siscovick, David S., Longstreth, W. T., Sidney, Stephen, Raghunathan, Trivellore E., Quesenberry, Charles P., Kelaghan, Joseph
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.11.1998; American Heart Association, Inc
• Subjects: Adolescent; Adult; Biological and medical sciences; Brain Ischemia - chemically induced; Brain Ischemia - complications; Brain Ischemia - epidemiology; California - epidemiology; Cerebral Hemorrhage - chemically induced; Cerebral Hemorrhage - complications; Cerebral Hemorrhage - epidemiology; Cerebrovascular Disorders - chemically induced; Cerebrovascular Disorders - epidemiology; Cerebrovascular Disorders - etiology; Contraceptives, Oral - administration & dosage; Contraceptives, Oral - adverse effects; Female; Humans; Medical sciences; Neurology; Progesterone Congeners - administration & dosage; Progesterone Congeners - adverse effects; Risk Factors; Vascular diseases and vascular malformations of the nervous system; Washington - epidemiology; Washington; California; Human; Nervous system diseases; Stroke; Low dose; Oral administration; Cardiovascular disease; Hemorrhage; Cerebral disorder; Vascular disease; Ischemia; Central nervous system disease; Young adult; Risk factor; Female; Contraceptive; Cerebrovascular disease
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/01.STR.29.11.2277

Background and Purpose —The available data on low-dose oral contraceptive pill (OCP) use and stroke risk in US women are limited by small numbers. We sought more precise estimates by conducting a pooled analysis of data from 2 US population–based case-control studies. Methods —We analyzed interview data from 175 ischemic stroke cases, 198 hemorrhagic stroke cases, and 1191 control subjects 18 to 44 years of age. Results —For ischemic stroke, the pooled odds ratio (pOR) adjusted for stroke risk factors for current use of low-dose OCPs compared with women who had never used OCP (never users) was 0.66 (95% confidence interval [CI], 0.29 to 1.47) and compared with women not currently using OCPs (nonusers) the pOR was 1.09 (95% CI, 0.54 to 2.21). For hemorrhagic stroke, the pOR for current use of low-dose OCPs compared with never users was 0.95 (95% CI, 0.46 to 1.93) and compared with nonusers the pOR was 1.11 (95% CI, 0.61 to 2.01). The pORs for current low-dose OCP use and either stroke type were not elevated among women who were ≥35 years, cigarette smokers, obese, or not receiving medical therapy for hypertension. pORs for current low-dose OCP use were 2.08 (95% CI, 1.19 to 3.65) for ischemic stroke and 2.15 (95% CI, 0.85 to 5.45) for hemorrhagic stroke among women reporting a history of migraine but were not elevated among women without such a history. Past OCP use (irrespective of formulation) was inversely related to ischemic stroke but unrelated to hemorrhagic stroke. Conclusions —Women who use low-dose OCPs are, in the aggregate, not at increased risk of stroke. Studies are needed to clarify the risk of stroke among users who may be susceptible on the basis of age, smoking, obesity, hypertension, or migraine history.