Risk of Arterial Thrombosis in Relation to Oral Contraceptives (RATIO) Study

Abstract

Background and Purpose-Epidemiological studies have shown an increased risk of venous thrombosis in women takingthird-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).

Prevalence of cardiovascular disease and cancer during cross-sex hormone therapy in a large cohort of trans persons: a case–control study

“…The latter found a higher mortality rate due to CVD in trans women aged between 40 and 64 years. Oral contraceptive use and hormone replacement therapy have been reported to be associated with an increased risk of CVD (20,21), and our results suggest that this may also be true for cross-sex hormone therapy in trans women.…”

Contracepção hormonal e sistema cardiovascular

“…Just like for VTE, the use of COC is also associated with increased risk of AT [38][39][40] . This risk is directly related to the dose of the estrogen component, but even in users of low-dose pills (EE<50 mcg), there was an increase in this risk 41 .…”

“…Unlike VTE, the type of progestagen associated with EE does not significantly change the risk of AT 38,40,41 .…”

“…Thus, at the moment, when one thinks about not causing any significant increase in the risk of AMI, the dose of EE has to be smaller than 50 mcg and it is important to identify risk factors for CVD, before prescribing the contraception method 7,[38][39][40][41] . Cerebrovascular accident (CVA) is another very rare blood disease among women at the reproductive age 43 .…”

“…hormonal methods 40 . The risk of stroke, as in previous studies, was not related to the associated progestagen 40,45 .…”