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  • Title: Fatal stroke and use of oral contraceptives: findings from a case-control study.
    Author: Thorogood M, Mann J, Murphy M, Vessey M.
    Journal: Am J Epidemiol; 1992 Jul 01; 136(1):35-45. PubMed ID: 1415130.
    Abstract:
    A case-control study of women less than 40 years of age in England and Wales was performed to evaluate the risk of fatal stroke associated with the use of the newer, low-dose oral contraceptives. Included were 296 cases with subarachnoid hemorrhage, 105 cases with other hemorrhagic stroke, and 21 cases with occlusive stroke, all of which occurred during 1986-1988. Two living controls per case, matched for age and marital status, were chosen from the general practice lists. The power of the study was such that the minimum significant increased relative risk of subarachnoid hemorrhage associated with ever having used oral contraceptives that could have been detected with 90% certainty was 1.6; the equivalent value for occlusive stroke was 28.4. Relative risk was estimated by conditional logistic regression allowing for matching. The adjusted relative risk of subarachnoid hemorrhage associated with oral contraceptives was estimated to be 1.1 (95% confidence interval (CI) 0.6-1.9) for current use and 1.3 (95% CI 0.9-1.8) for ever use, while the equivalent relative risk of an occlusive stroke associated with ever use was 4.4 (95% CI 0.8-24.4). Oral contraceptive use may be associated with a small increase in the risk of subarachnoid hemorrhage. These data are consistent with a substantial increase in the risk of occlusive stroke associated with oral contraceptive use. Epidemiologists compared data on 434 cases of fatal stroke which occurred between 1986-88 in England and Wales with data on 1268 living matched controls to determine the association between use of the newer, low dose oral contraceptives (OCs) and the risk of stroke. History of hypertension was significantly associated with a 9-fold rise in the risk of subarachnoid hemorrhage (p.001) and an 8-fold rise in the risk of any hemorrhagic stroke. History of preeclampsia was also significantly associated with subarachnoid hemorrhage (p.01) and any hemorrhagic stroke. Cigarette smoking had a 2.6-fold increased risk of subarachnoid hemorrhage (p.001). The epidemiologists found an estimated relative risk of subarachnoid hemorrhage related to current OC use to be only 1.1 and when they controlled for confounding factors it was still small and insignificant (1.3). The power of the study showed the lowest significant increased relative risk of subarachnoid hemorrhage related to OC use that epidemiologists could have detected with 90% certainty to be 1.6. When the epidemiologists controlled for confounding factors, the insignificant relative risk of occlusive stroke associated with OC use was 4.4 while the power of the study indicated it to be 28.4. This was consistent with other studies, but other studies found the association to be significant. These findings revealed a possible small increase in the risk of subarachnoid hemorrhage associated with OC use.
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