Oral Contraceptive Use And Increased Risk Of Stroke

Background: Oral contraceptive(OCP)use has been reported to be related to stroke in women.However,it is inconclusive about the dose–response relation between OCP use and the risk of stroke,especially in young and middle-aged women.Methods: We obtained relevant articles by conducting a retrieval of PubMed,EMBASE,and Cochrane Library databases.The does of three dimension of OCP use and corresponding odds ratios(ORs)with 95% confidence intervals(CIs)was collected.A two-stage dose–response analysis was conducted by a random-effects model and a restricted spline model.Results: A total of 18 articles(6 cohort studies and 12 case–control studies)involved with 2,143,174 participants and 11,661 cases of stroke were identified.The OR of total stroke risk was 1.19(95%CI,1.16–1.23)for every 10-?g increment in estrogen dosage,1.20(95%CI,1.05–1.37)for every 5-year increment in duration of OCP use,and 0.82(95%CI,0.68–0.98)for every 5-year increment in duration of OCP discontinuation.The OR of ischemic stroke(IS)risk was 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 discontinuation.The OR of hemorrhagic stroke(HS)risk was 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 discontinuation.Conclusion: Higher estrogen dosage was significantly associated with the increased risk of total stroke,IS and HS.Longer duration of OCPs use significantly contributed the increased risk of total stroke and IS,while its effects on risk of HS was marginal.The duration of OCPs discontinuation was negatively associated with the risk of stroke.These definitely confirmed the dose-dependence of estrogen dose in OCPs and OCPs duration in stroke incidence.