Abstract WP212: Opportunities for Prevention of Oral Contraceptive-Associated Ischemic Stroke:The Stroke Prevention in Young Women Study

Abstract

Background and Purpose: Current use of oral contraceptives (OCs) has been associated with increased risk of ischemic stroke. We sought to determine whether elevated stroke risk in women using OCs was restricted to women with other concurrent high risk conditions (risk modifiers), whether patients with these conditions recalled being advised not to use or to stop using OCs, and whether this advice resulted in behavioral change. Methods: 59 hospitals in the Baltimore-Washington area participated in a population based case-control study of stroke in young women ages 15 to 49 (228 cases/348 controls). Data on OC use was gathered through standardized interview. Potential risk modifiers to OC use included hypertension, smoking, headache, chest pain or heart attack, and blood clots in the legs or lungs. Results: Overall the unadjusted odds ratio for OC use and stroke was 1.5 (95% CI: 1.0-2.3). Participants who had one or more potential risk modifiers to OC use while using OCs had an OR of 2.4 (95% CI: 1.3-4.3), while participants without any of these conditions had an OR of 1.1 (95% CI: 0.6-1.9). The most common conditions cited were smoking and headache. Thirty-eight women with ≥1 high risk conditions recalled being advised not to start OCs; however 9 (24%) of these women were taking OCs at the time of stroke or interview. There were 93 women with ≥1 high risk conditions who recalled being told to discontinue OCs, of whom 14 (15%) were still taking OCs at the time of stroke or interview. Conclusions: Our data are consistent with prior studies suggesting that increased the risk of stroke associated with OC use is restricted primarily to women with concurrent high risk conditions, such as headache or smoking. Improved physician and patient education about the medical conditions associated with higher stroke risk among OC users and a better understanding of the dynamics of the physician-patient encounter could further reduce risk.