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  • Title: Cerebrovascular deaths before and after the appearance of oral contraceptives.
    Author: Lidegaard O.
    Journal: Acta Neurol Scand; 1987 Jun; 75(6):427-33. PubMed ID: 3630638.
    Abstract:
    The mortality of cerebrovascular diseases in Denmark was analysed for men and women 15-44 years of age, in a 14-year period before and after the appearance of oral contraceptives (OC) in 1966. 1,670 deaths were registered over 28 years, during which the female incidence of cerebrovascular deaths increased by 19% (P less than 0.025), while the male mortality was unchanged. Women showed a percentage increase in deaths from cerebral thromboembolic attacks (CTA) of 33%, men a fall of 14%. The increase of female CTA deaths was most pronounced in the young fertile group, the age group with a high OC use. A relative risk of CTA of 3.3-4.5 for OC users compared with non-users could explain the CTA trend difference between women and men. No other single risk factor responsible for the observed trends could be identified. Both women and men had a significant increase in the mortality of subarachnoidal hemorrhages, and a significant fall in the mortality of intracerebral hemorrhages. The aim of this study was to investigate cerebrovascular deaths in Denmark in 15-44 year old men and women for the 14-year period prior to the introduction of oral contraceptives (OCs) in late 1966 compared with the subsequent 14 years. Study data were derived from annual vital statistics from 1953-80. A total of 1670 cerebrovascular deaths were recorded over the 28 years reviewed. During this period, the female incidence of cerebrovascular deaths increased by 19% while male mortality was constant. However, there were differences within the 3 subgroups of cerebrovascular deaths. In terms of cerebral thromboembolism, there was a 33% increase among women in the death rate between the 2 periods studied contrasted with a 14% decline in deaths among men. The female rate increase was most marked in the 15-34-year age group. Deaths from subarachnoid hemorrhage increased significantly for both sexes between the 2 periods--38% for men and 67% for women. Here, the increases in mortality were greatest for men and women 35-44 years of age. Finally, deaths from intracerebral hemorrhages fell by 37% for men and 22% for women during the study periods. The etiology of cerebral thromboembolism is multifactorial, involving factors such as diet, hypertensive control, cigarette smoking, and occupational thrombogenic factors. However, the dramatic increase of 33% recorded among women in deaths from cerebral thromboembolism after 1966 seems to suggest that OCs have played a significant role in the changes in female deaths from this cause. Further epidemiological studies are necessary to support or reject the hypothesis that OCs have had a major impact on the mortality profile of young women in recent years.
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