(Stroke. 1998;29:2277-2284.)
© 1998 American Heart Association, Inc.
Original Contributions |
Stroke and Use of Low-Dose Oral Contraceptives in Young Women
A Pooled Analysis of Two US Studies
From the Cardiovascular Health Research Unit (S.M.S., D.S.S., W.T.L.), the Department of Epidemiology, School of Public Health and Community Medicine (S.M.S., D.S.S., W.T.L.), the Division of General Internal Medicine, Department of Medicine, School of Medicine (D.S.S.), the Department of Neurology, School of Medicine (W.T.L.), and the Department of Biostatistics, School of Public Health and Community Medicine (T.E.R.), University of Washington, Seattle, Wash; Research and Evaluation, Southern California Permanente Medical Group (D.B.P.), Pasadena, Calif; Division of Research, KP Medical Care Program, Northern California (S.S.), Oakland, Calif; and the Contraception and Reproductive Health Branch, National Institute of Child Health and Human Development (J.K.), Bethesda, Md.
Correspondence and reprint requests to Stephen M. Schwartz, PhD, Cardiovascular Health Research Unit, 1730 Minor Ave, Suite 1360, Seattle, WA 98101. E-mail stevesch{at}u.washington.edu
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.
Key Words: contraceptives, oral • stroke, hemorrhagic • stroke, ischemic • women
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