Risk of arterial thrombosis in relation to oral contraceptives (RATIO) study - Oral contraceptives and the risk of ischemic stroke

被引:152
作者
Kemmeren, JM
Tanis, BC
van den Bosch, MAAJ
Bollen, ELEM
Helmerhorst, FM
van der Graaf, Y
Rosendaal, FR
Algra, A
机构
[1] Univ Utrecht, Med Ctr, Julius Ctr Gen Practice & Patient Oriented Res, NL-3508 GA Utrecht, Netherlands
[2] Univ Utrecht, Med Ctr, Dept Neurol, NL-3508 GA Utrecht, Netherlands
[3] Leiden Univ, Med Ctr, Dept Haematol, Leiden, Netherlands
[4] Leiden Univ, Med Ctr, Dept Neurol, Leiden, Netherlands
[5] Leiden Univ, Med Ctr, Dept Obstet Gynecol & Reprod Med, Leiden, Netherlands
[6] Leiden Univ, Med Ctr, Dept Clin Epidemiol, Leiden, Netherlands
关键词
contraceptives; oral; epidemiology; estrogens; progestins; stroke; ischemic;
D O I
10.1161/01.STR.0000015345.61324.3F
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background and Purpose-Epidemiological studies have shown an increased risk of venous thrombosis in women taking third-generation oral contraceptives, ie, those containing the progestogens desogestrel or gestodene. This study assesses the risk of ischemic stroke with several types of oral contraceptives. Methods-A multicenter, population-based, case-control study was performed in 9 Dutch centers in women aged 18 to 49 years. Women with a first ischemic stroke were compared with control women without vascular diseases. The control subjects were recruited by random-digit dialing and were stratified by age. area of residence, and year of stroke. All patients and control subjects filled in a questionnaire about the use of oral contraceptives and risk factors for ischemic stroke. Odds ratios were adjusted for the stratification factors. Results-Two hundred three women with an ischemic stroke and 925 control women were included. The risk of stroke in women using any type of oral contraceptives versus none was 2.3 (95% CI 1.6 to 3.3). Current users of first-generation oral contraceptives had an odds ratio of 1.7 (95% CI 0.7 to 4.4). Low-dose second-generation oral contraceptives increased the risk of stroke 2.4 times (95% CI 1.6 to 3.7), and third-generation oral contraceptives increased the risk of stroke 2.0 times (95% CI 1.2 to 3.5). The risk of stroke in women using third-generation oral contraceptives was not different from that in women using second-generation oral contraceptives (odds ratio 1.0, 95% CI 0.6 to 1.8). Conclusions-Third-generation oral contraceptives (containing desogestrel or gestodene) confer the same risk of first ischemic stroke as second-generation oral contraceptives (containing levonorgestrel).
引用
收藏
页码:1202 / 1208
页数:7
相关论文
共 29 条
[1]  
[Anonymous], 1975, JAMA, V231, P718
[2]   ENHANCEMENT BY FACTOR-V LEIDEN MUTATION OF RISK OF DEEP-VEIN THROMBOSIS ASSOCIATED WITH ORAL-CONTRACEPTIVES CONTAINING 3RD-GENERATION PROGESTAGEN [J].
BLOEMENKAMP, KWM ;
ROSENDAAL, FR ;
HELMERHORST, FM ;
BULLER, HR ;
VANDENBROUCKE, JP .
LANCET, 1995, 346 (8990) :1593-1596
[3]   CORONARY THROMBOSIS AND CONOVID [J].
BOYCE, J ;
FAWCETT, JW ;
NOALL, EWP .
LANCET, 1963, 1 (727) :111-&
[4]   Increased risk of cerebral venous sinus thrombosis with third-generation oral contraceptives [J].
de Bruijn, SFTM ;
Stam, J ;
Vandenbroucke, JP .
LANCET, 1998, 351 (9113) :1404-1404
[5]   NEW PROGESTOGENS IN ORAL CONTRACEPTION [J].
FOTHERBY, K ;
CALDWELL, ADS .
CONTRACEPTION, 1994, 49 (01) :1-32
[6]   STROKE PREVENTION [J].
GORELICK, PB .
ARCHIVES OF NEUROLOGY, 1995, 52 (04) :347-355
[7]   2 ONE-STEP METHODS FOR HOUSEHOLD SCREENING AND INTERVIEWING USING RANDOM DIGIT DIALING [J].
HARLOW, BL ;
DAVIS, S .
AMERICAN JOURNAL OF EPIDEMIOLOGY, 1988, 127 (04) :857-863
[8]   RANDOM DIGIT DIALING IN SELECTING A POPULATION-BASED CONTROL-GROUP [J].
HARTGE, P ;
BRINTON, LA ;
ROSENTHAL, JF ;
CAHILL, JI ;
HOOVER, RN ;
WAKSBERG, J .
AMERICAN JOURNAL OF EPIDEMIOLOGY, 1984, 120 (06) :825-833
[9]   Thromboembolic stroke in young women - A European case-control study on oral contraceptives [J].
Heinemann, LAJ ;
Lewis, MA ;
Spitzer, WO ;
Thorogood, M ;
Guggenmoos-Holzmann, I ;
Bruppacher, R .
CONTRACEPTION, 1998, 57 (01) :29-37
[10]   RISK OF IDIOPATHIC CARDIOVASCULAR DEATH AND NONFATAL VENOUS THROMBOEMBOLISM IN WOMEN USING ORAL-CONTRACEPTIVES WITH DIFFERING PROGESTAGEN COMPONENTS [J].
JICK, H ;
JICK, SS ;
GUREWICH, V ;
MYERS, MW ;
VASILAKIS, C .
LANCET, 1995, 346 (8990) :1589-1593