Association between oral contraceptives and risk of hemorrhagic stroke: a meta-analysis of observational studies

Xu, Zhenlin; Yue, Yuanping; Bai, Jianling; Shen, Chong; Yang, Jingjing; Huang, Xiaoping; Zhao, Yang; Li, Ying

doi:10.1007/s00404-018-4723-7

Cited by 21 publications

(38 citation statements)

References 36 publications

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“…Twenty three reviews reported overlapping associations. 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 Overlapping associations included: current use of combined oral contraceptives and risk of myocardial infarction, n=2 55 56 ; use of combined oral contraceptives and risk of ischaemic stroke, n=3 55 56 67 ; use of combined oral contraceptives and risk of haemorrhagic stroke, n=2 56 71 ; use of progesterone only pill and risk of stroke, n=2 72 73 ; use of combined oral contraceptives in migraine and risk of stroke, n=2 74 75 ; early menarche and mortality from cardiovascular disease, n=2 76 77 ; early menopause and risk of fatal cardiovascular disease, n=3 57 58 59 ; pre-eclampsia and risk of cardiovascular disease, n=2 60 61 ; gestational diabetes and risk of cardiovascular disease, n=3 62 63 69 ; preterm birth and risk of cardiovascular disease, n=3 60 64 65 ; and polycystic ovary syndrome and risk of cardiovascular disease, n=3. 66 68 70 Appendix 8 describes the general characteristics of the reviews with overlapping associations, including the decision to retain or exclude an association from the analysis.…”

Section: Resultsmentioning

confidence: 99%

“…Current use of any oral contraceptives (combined oral contraceptives and progesterone only pill), recurrent pre-eclampsia, and pre-eclampsia were associated with a twofold or more increased risk of stroke; maternal delivery of preterm infants, gestational diabetes, and current use of combined oral contraceptives were associated with a 1.5-1.9-fold increase in risk; and polycystic ovary syndrome was associated with a less than 1.5-fold increase in risk ( fig 6 ). 55 57 59 60 61 63 64 67 71 72 76 85 88 96 97 98 99 102 …”

Section: Resultsmentioning

confidence: 99%

“…67 71 The increase in risk was greater for ischaemic stroke 67 than haemorrhagic stroke. 71 The risk of both ischaemic and haemorrhagic stroke was greatest in women on higher doses of oestrogen, who had hypertension, were smokers, or were aged over 35 (supplementary table 3).…”

Section: Use Of Oral Contraceptivesmentioning

confidence: 99%

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Association between the reproductive health of young women and cardiovascular disease in later life: umbrella review

Okoth

Chandan

Marshall

et al. 2020

BMJ

235

171

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Objective To consolidate evidence from systematic reviews and meta-analyses investigating the association between reproductive factors in women of reproductive age and their subsequent risk of cardiovascular disease. Design Umbrella review. Data sources Medline, Embase, and Cochrane databases for systematic reviews and meta-analyses from inception until 31 August 2019. Review methods Two independent reviewers undertook screening, data extraction, and quality appraisal. The population was women of reproductive age. Exposures were fertility related factors and adverse pregnancy outcomes. Outcome was cardiovascular diseases in women, including ischaemic heart disease, heart failure, peripheral arterial disease, and stroke. Results 32 reviews were included, evaluating multiple risk factors over an average follow-up period of 7-10 years. All except three reviews were of moderate quality. A narrative evidence synthesis with forest plots and tabular presentations was performed. Associations for composite cardiovascular disease were: twofold for pre-eclampsia, stillbirth, and preterm birth; 1.5-1.9-fold for gestational hypertension, placental abruption, gestational diabetes, and premature ovarian insufficiency; and less than 1.5-fold for early menarche, polycystic ovary syndrome, ever parity, and early menopause. A longer length of breastfeeding was associated with a reduced risk of cardiovascular disease. The associations for ischaemic heart disease were twofold or greater for pre-eclampsia, recurrent pre-eclampsia, gestational diabetes, and preterm birth; 1.5-1.9-fold for current use of combined oral contraceptives (oestrogen and progesterone), recurrent miscarriage, premature ovarian insufficiency, and early menopause; and less than 1.5-fold for miscarriage, polycystic ovary syndrome, and menopausal symptoms. For stroke outcomes, the associations were twofold or more for current use of any oral contraceptive (combined oral contraceptives or progesterone only pill), pre-eclampsia, and recurrent pre-eclampsia; 1.5-1.9-fold for current use of combined oral contraceptives, gestational diabetes, and preterm birth; and less than 1.5-fold for polycystic ovary syndrome. The association for heart failure was fourfold for pre-eclampsia. No association was found between cardiovascular disease outcomes and current use of progesterone only contraceptives, use of non-oral hormonal contraceptive agents, or fertility treatment. Conclusions From menarche to menopause, reproductive factors were associated with cardiovascular disease in women. In this review, presenting absolute numbers on the scale of the problem was not feasible; however, if these associations are causal, they could account for a large proportion of unexplained risk of cardiovascular disease in women, and the risk might be modifiable. Identifying reproductive risk factors at an early stage in the life of women might facilitate the initiation of strategies to modify potential risks. Policy makers should consider incorporating reproductive risk factors as part of the assessment of cardiovascular risk in clinical guidelines. Systematic review registration PROSPERO CRD42019120076.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Association between the reproductive health of young women and cardiovascular disease in later life: umbrella review

Okoth

Chandan

Marshall

et al. 2020

BMJ

235

171

View full text Add to dashboard Cite

show abstract

“…It is important to note that part of the study group were women using various forms of hormonal contraception (40.4%). The latest reports about mixing hormone-based contraceptives with nicotine confirm an increased risk of hemorrhagic stroke in women who smoke cigarettes and use oral contraceptives [21,22]. Another study investigating the attitudes of women using hormonal contraceptives towards quitting smoking has revealed that only 10% of them stopped smoking after starting to use hormone-based contraception, whereas the remaining 90%, by continuing to smoke, increased their risk of venous thromboembolic disease.…”

Section: Discussionmentioning

confidence: 99%

Health behaviors and quality of life in fertile women using contraception

Błażejewska

Branecka-Woźniak

Stanisz

et al. 2019

Pomeranian Journal of Life Sciences

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Introduction: Early sexual initiation, the phenomenon of promiscuity, and voluntary childlessness are some reasons behind contraception use by women. Health-related behaviors determine the state of human health and are closely related to quality of life. The aim of the study was to analyze the manifestations of prohealth behaviors and to examine their impact on the quality of life in a group of fertile women using any form of contraception.Materials and methods: Research material was collected from August 2017 to January 2018 in the West Pomeranian Voivodship, from 183 women of childbearing age who had been using contraception. The questionnaire consisted of a author’s part and the WHOQOL-BREF questionnaire. Statistical analysis used descriptive and analytical methods, such as the Shapiro–Wilk test and the analysis of variance (ANOVA) test. A structure index containing a percentage was used. The results obtained were statistically analyzed using χ2 test for independent samples. The probability value of p < 0.05 was considered statistically significant.Results: Among pro-health behaviors, 80.9% of the women declared that they performed some physical activity at least once a week, 76% stated that their eating habits were correct, 47% went to a gynecologist once a year, 83.6% claimed they regularly performed preventive examinations. The better the subjective assessment of health, the higher the quality of life in the psychological domain (p < 0.001). The better the nutritional habits were assessed, the better the quality of life in the environment domain (p < 0.05). Not using stimulants had a positive impact on the quality of life in the physical health domain (p < 0.05). A rise in the frequency of follow-up visits to a gynecologist led to a rise in the quality of life in social relationships and physical health domains (p < 0.05).Conclusions: The manifestation of pro-health behaviors in women of childbearing age who use contraception has a positive influence on the quality of their lives in almost all the domains. The overriding purpose of pro-health education is to strengthen the actions of women who display healthy behaviors and, in the case of those exposed to a reduced quality of life due to unhealthy practices, conduct intervention and preventive actions while respecting the woman’s individual biopsychosocial needs.

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“…A recent meta-analysis indicated that the risk of first-ever ischemic stroke (IS) was increased significantly in females currently taking OCPs (11). Similarly, another meta-analysis study showed that current OCP use led to a small increase in hemorrhagic stroke (HS) incidence (12). Although Roach et al found that the OCP users were not at increased risk of IS, they stratified their meta-analysis according to estrogen dose and found that there was significant risk of stroke in women taking combined OCPs with estrogen doses more than 50 μg (13).…”

Section: Introductionmentioning

confidence: 99%

Oral Contraceptive Use and Increased Risk of Stroke: A Dose–Response Meta-Analysis of Observational Studies

Zhu

Zhang

et al. 2019

Front. Neurol.

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Background: Oral contraceptive (OCP) use might increase the risk of stroke in women. We examined a possible dose–response relation between OCP use and the risk of stroke in young and middle-aged women.Methods: A retrieval of PubMed and EMBASE databases was performed. We selected observational studies that reported odds ratios (ORs) with 95% confidence intervals (CIs) for the risk of stroke in OCP users. A two-stage dose–response analysis was conducted using the random-effects model and the restricted spline model.Results: A total of 6 cohort studies and 12 case–control studies were included, which involved 2,143,174 participants and 11,661 cases of stroke including ischemic stroke (IS), hemorrhagic stroke (HS), and stroke of unknown origin. The pooled ORs of total stroke were 1.19 (95% CI, 1.16–1.23) for every 10-μg increment in estrogen dosage, 1.20 (95% CI, 1.05–1.37) for every 5-years increment in duration of OCP use, and 0.82 (95% CI, 0.68–0.98) for every 5-years increment in duration of OCP cessation. The ORs of IS were 1.20 (95% CI, 1.17–1.22) in estrogen dosage, 1.24 (95% CI, 1.04–1.49) in duration of OCP use, and 0.78 (95% CI, 0.67–0.92) in duration of OCP cessation. The ORs of HS were 1.10 (95% CI, 1.04–1.16) in estrogen dosage, 1.13 (95% CI, 0.93–1.36) in duration of OCPs, and 0.71 (95% CI, 0.55–0.92) in duration of OCP cessation. The pooled ORs of total stroke from prospective studies (1.12; 95% CI, 1.01–1.24) were lower than those from retrospective studies (1.30; 95% CI, 1.01–1.67).Conclusions: The higher estrogen dosage significantly increased the risks of total stroke, IS, and HS, respectively. The longer duration of OCP use significantly increased the risks of total stroke and IS, but its effects on HS risk were marginal. The longer duration of OCP cessation significantly decreased the risks of total stroke, IS, and HS, respectively. These findings affirm the contribution of estrogen dose and duration of OCP use to the increased risk of stroke, which may be critical for the instruction of OCP use and the prevention and management of cerebrovascular diseases.

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Association between oral contraceptives and risk of hemorrhagic stroke: a meta-analysis of observational studies

Abstract: This meta-analysis of observational studies suggests that current use of OCs could contribute to a small increased risk of hemorrhagic stroke, and the increased risk is related to subarachnoid hemorrhage, but not intracerebral hemorrhage.

Cited by 21 publications

References 36 publications

Association between the reproductive health of young women and cardiovascular disease in later life: umbrella review

Association between the reproductive health of young women and cardiovascular disease in later life: umbrella review

Health behaviors and quality of life in fertile women using contraception

Oral Contraceptive Use and Increased Risk of Stroke: A Dose–Response Meta-Analysis of Observational Studies

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