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  • Title: [Vascular disease and hormonal treatment--epidemiology].
    Author: Vessey MP.
    Journal: Contracept Fertil Sex (Paris); 1985 Jan; 13(1 Suppl):121-6. PubMed ID: 12280197.
    Abstract:
    Results of different studies conducted over the past 2 decades on the relationship between oral contraceptive (OC) use and venous thromboembolism, stroke, and myocardial infarct are summarized. The possibility that OCs would increase the risk of venous thrombosis was 1st raised by a case reported in 1961, and has been confirmed by at least 9 retrospective and 4 prospective studies in the UK, US, and Scandinavia. An increased risk of venous thrombosis has been confirmed only among women currently using OCs and possibly among those stopping use within 1-2 weeks. The risk is unrelated to duration of use, although few data are available on women using OCs continuously for more than 3 years. The proof of a relationship between risk of venous thrombosis and estrogen content is convincing, although an association with progestin content has also been suggested. Evidence is beginning to accumulate for an association between smoking and venous thrombosis in OC users and nonusers alike. British prospective studies have indicated a risk of death from venous thrombosis in OC users of 2-3/100,000 users/year during the 1970s, but modern low-dose formulations, better patient selection, and better surveillance have probably reduced the risk further. The evidence of a relationship between OC use and cerebral hemorrhage is only moderately convincing, with any increased risk unlikely to be more than 2-fold. The data regarding cerebral thrombosis are more consistent and convincing; they demonstrate a positive association of risk of cerebral thrombosis with both the estrogen and progestin content of OCs. Past as well as current users may be at increased risk, but data on the effect of duration of use are lacking. At least 9 retrospective and 2 prospective studies have established the significance of the risk of myocardial infarct in OC users. Risk of myocardial infarct may be related to both estrogen and progestin content, and appears to be limited to current users. Little evidence has been found of a relationship to duration of use. Strong evidence exists of a relationship between OC use and other risk factors for myocardial infarct, including smoking and hypertension. Very few deaths were observed from this cause in women under 35 in the 1970s. As with venous thrombosis, the mortality risks of stroke and myocardial infarct have probably declined appreciably in the past few years. OCs have been implicated in blood pressure elevations as well as a series of cardiovascular problems such as Budd-Chiari syndrome, occlusion of arteries in the intestines and extremities, and hemolytic uremic syndrome. The few available published studies suggest that administration of estrogens to peri- or postmenopausal women does not entail a cardiovascular risk.
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