Oral contraceptive use and cardiovascular disease: Is the relationship real or due to study bias?

David A Katerndahl, J. P. Realini, P. A. Cohen

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Epidemiologic studies link oral contraceptive (OC) use with several cardiovascular events, but the literature is difficult to summarize, and potential biases remain poorly addressed. This study uses meta-analysis to summarize study results and to analyze the influence of study characteristics, including susceptibility to bias, on study outcome. 47 case-control and cohort studies of OCs and 4 cardiovascular events were coded for relative risk (RR) and study characteristics, including adherence to 14 bias-control standards. Key RRs were pooled to summarize findings for each disease type. Univariate determinants of the magnitude of the RRs were identified, and partial correlation analysis was performed for each disease type. RRs were significantly greater then 1.0 for venous thromboembolism (RR=2.8, confidence interval ,CI]=2.4-3.2), stroke (RR=1.8, CI=16-2.0), and myocardial infarction (RR=1.6, CI=1.4-1.8, but not for death due to any cardiovascular cause (RR=1.0, CI=0.8-1.3). Study characteristics were diverse, and potential biases were frequently uncontrolled. For 3 of 10 study characteristics identified as independently influencing RR, methodologically stronger studies of venous thromboembolism tended to have higher RRs. In studies that were methodologically stronger where variables were identified as important, the RRs for stroke and myocardial infarction were stronger. In studies with cardiovascular death, bias-control standards identified as important were generally handled by the studies. OC use does not appear to increase overall cardiovascular mortality. The associations noted with stroke and myocardial infarction may be due to methodologic flaws within the studies, while the association with venous thromboembolism is more likely to be valid. author's modified

Original languageEnglish (US)
Pages (from-to)147-157
Number of pages11
JournalJournal of Family Practice
Volume35
Issue number2
StatePublished - 1992
Externally publishedYes

Fingerprint

Oral Contraceptives
Cardiovascular Diseases
Venous Thromboembolism
Confidence Intervals
Stroke
Myocardial Infarction
Meta-Analysis
Case-Control Studies
Epidemiologic Studies
Cohort Studies
Outcome Assessment (Health Care)
Mortality

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Oral contraceptive use and cardiovascular disease : Is the relationship real or due to study bias? / Katerndahl, David A; Realini, J. P.; Cohen, P. A.

In: Journal of Family Practice, Vol. 35, No. 2, 1992, p. 147-157.

Research output: Contribution to journalArticle

@article{cf563817e03d4ce7b5b65e45410a35e1,
title = "Oral contraceptive use and cardiovascular disease: Is the relationship real or due to study bias?",
abstract = "Epidemiologic studies link oral contraceptive (OC) use with several cardiovascular events, but the literature is difficult to summarize, and potential biases remain poorly addressed. This study uses meta-analysis to summarize study results and to analyze the influence of study characteristics, including susceptibility to bias, on study outcome. 47 case-control and cohort studies of OCs and 4 cardiovascular events were coded for relative risk (RR) and study characteristics, including adherence to 14 bias-control standards. Key RRs were pooled to summarize findings for each disease type. Univariate determinants of the magnitude of the RRs were identified, and partial correlation analysis was performed for each disease type. RRs were significantly greater then 1.0 for venous thromboembolism (RR=2.8, confidence interval ,CI]=2.4-3.2), stroke (RR=1.8, CI=16-2.0), and myocardial infarction (RR=1.6, CI=1.4-1.8, but not for death due to any cardiovascular cause (RR=1.0, CI=0.8-1.3). Study characteristics were diverse, and potential biases were frequently uncontrolled. For 3 of 10 study characteristics identified as independently influencing RR, methodologically stronger studies of venous thromboembolism tended to have higher RRs. In studies that were methodologically stronger where variables were identified as important, the RRs for stroke and myocardial infarction were stronger. In studies with cardiovascular death, bias-control standards identified as important were generally handled by the studies. OC use does not appear to increase overall cardiovascular mortality. The associations noted with stroke and myocardial infarction may be due to methodologic flaws within the studies, while the association with venous thromboembolism is more likely to be valid. author's modified",
author = "Katerndahl, {David A} and Realini, {J. P.} and Cohen, {P. A.}",
year = "1992",
language = "English (US)",
volume = "35",
pages = "147--157",
journal = "Journal of Family Practice",
issn = "0094-3509",
publisher = "Appleton-Century-Crofts",
number = "2",

}

TY - JOUR

T1 - Oral contraceptive use and cardiovascular disease

T2 - Is the relationship real or due to study bias?

AU - Katerndahl, David A

AU - Realini, J. P.

AU - Cohen, P. A.

PY - 1992

Y1 - 1992

N2 - Epidemiologic studies link oral contraceptive (OC) use with several cardiovascular events, but the literature is difficult to summarize, and potential biases remain poorly addressed. This study uses meta-analysis to summarize study results and to analyze the influence of study characteristics, including susceptibility to bias, on study outcome. 47 case-control and cohort studies of OCs and 4 cardiovascular events were coded for relative risk (RR) and study characteristics, including adherence to 14 bias-control standards. Key RRs were pooled to summarize findings for each disease type. Univariate determinants of the magnitude of the RRs were identified, and partial correlation analysis was performed for each disease type. RRs were significantly greater then 1.0 for venous thromboembolism (RR=2.8, confidence interval ,CI]=2.4-3.2), stroke (RR=1.8, CI=16-2.0), and myocardial infarction (RR=1.6, CI=1.4-1.8, but not for death due to any cardiovascular cause (RR=1.0, CI=0.8-1.3). Study characteristics were diverse, and potential biases were frequently uncontrolled. For 3 of 10 study characteristics identified as independently influencing RR, methodologically stronger studies of venous thromboembolism tended to have higher RRs. In studies that were methodologically stronger where variables were identified as important, the RRs for stroke and myocardial infarction were stronger. In studies with cardiovascular death, bias-control standards identified as important were generally handled by the studies. OC use does not appear to increase overall cardiovascular mortality. The associations noted with stroke and myocardial infarction may be due to methodologic flaws within the studies, while the association with venous thromboembolism is more likely to be valid. author's modified

AB - Epidemiologic studies link oral contraceptive (OC) use with several cardiovascular events, but the literature is difficult to summarize, and potential biases remain poorly addressed. This study uses meta-analysis to summarize study results and to analyze the influence of study characteristics, including susceptibility to bias, on study outcome. 47 case-control and cohort studies of OCs and 4 cardiovascular events were coded for relative risk (RR) and study characteristics, including adherence to 14 bias-control standards. Key RRs were pooled to summarize findings for each disease type. Univariate determinants of the magnitude of the RRs were identified, and partial correlation analysis was performed for each disease type. RRs were significantly greater then 1.0 for venous thromboembolism (RR=2.8, confidence interval ,CI]=2.4-3.2), stroke (RR=1.8, CI=16-2.0), and myocardial infarction (RR=1.6, CI=1.4-1.8, but not for death due to any cardiovascular cause (RR=1.0, CI=0.8-1.3). Study characteristics were diverse, and potential biases were frequently uncontrolled. For 3 of 10 study characteristics identified as independently influencing RR, methodologically stronger studies of venous thromboembolism tended to have higher RRs. In studies that were methodologically stronger where variables were identified as important, the RRs for stroke and myocardial infarction were stronger. In studies with cardiovascular death, bias-control standards identified as important were generally handled by the studies. OC use does not appear to increase overall cardiovascular mortality. The associations noted with stroke and myocardial infarction may be due to methodologic flaws within the studies, while the association with venous thromboembolism is more likely to be valid. author's modified

UR - http://www.scopus.com/inward/record.url?scp=0027100468&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0027100468&partnerID=8YFLogxK

M3 - Article

C2 - 1386621

AN - SCOPUS:0027100468

VL - 35

SP - 147

EP - 157

JO - Journal of Family Practice

JF - Journal of Family Practice

SN - 0094-3509

IS - 2

ER -