Ischemic stroke risk in oral contraceptive users.

Contraceptive Users To the Editor: We read with interest the article by Siritho et al on ischemic stroke risk in oral contraceptive users.1 This case-control study seems well conducted, but the conclusion is not consequential to the results obtained. The conclusion of a study is of crucial importance when it deals with the practical implication of the study itself, which, in the case in point, is done to reconsider the current recommendations that restrict the use of the oral contraceptive pill (OCP) to younger women who do not have other risk factors for cardiovascular disease.2 The authors in their conclusion “recommend that the OCP (in low doses) be prescribed with care” and add that “particular care should be taken among women with a history of smoking, hypertension, diabetes mellitus, and myocardial infarction and in those with a family history of stroke.”1 This conclusion, in discordance with the study results, deserves some considerations: 1. The principle that OCP, as any other drug, must be prescribed with care is a good and notorious one but it has not been shown in the present case-control study, which did not find any evidence for an association between ischemic stroke and OCP use. 2. It is not clear what the authors mean by “particular care” in prescribing OCP to patients with risk factors for cerebrovascular diseases. Rather, the authors do not answer the real question on whether to prescribe or not to prescribe OCP in “women with a history of smoking, hypertension, diabetes mellitus, and myocardial infarction and in those with a family history of stroke.” 3. This article shows that OCP in low doses does not increase the risk of stroke in women with risk factors for cardiovascular disease. Therefore, the practical implications should have indicated that the presence of smoking, hypertension, diabetes mellitus, and myocardial infarction and a family history of stroke should not discourage from prescribing OCP when the alternative is a risky and undesired pregnancy.