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Results for “Meta- analysis”

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PubMed1994

Vaginal bleeding and adverse reproductive outcomes: a meta-analysis.

The objective of this paper is to characterise and quantify the association between vaginal bleeding and pregnancy outcome. A meta-analysis was performed in order to quantify the risk of adverse reproductive outcome by combining evidence from all previous studies of vaginal bleeding. The reproductive endpoints considered were low birthweight, preterm birth, stillbirth, perinatal death and congenital malformation. The meta-analysis confirms an association of vaginal bleeding with adverse pregnancy outcomes, but identified discrepancies in the reported risks of vaginal bleeding and magnitudes of association between bleeding and adverse reproductive outcomes, observed across studies. These discrepancies may be attributed to inconsistent definitions of the timing and severity of vaginal bleeding. The implications of such inconsistencies are discussed, suggesting a need for more standardised definitions of vaginal bleeding and reproductive endpoints in future studies.

Abortion, Threatened↗

PubMed2005

Effect of osteoporosis treatments on risk of non-vertebral fractures: review and meta-analysis of intention-to-treat studies.

Most osteoporosis treatments have proven efficacy in reducing the risk of vertebral fractures, whereas evidence is less straightforward for prevention of non-vertebral fractures. Conclusions as to the efficacy of a treatment should be based primarily on analyses of the intention to treat (ITT) population rather than on exploratory subgroup analyses; however, non-vertebral anti-fracture efficacy has been largely derived by post-hoc subgroup analyses. This review and meta-analysis was performed to assess non-vertebral anti-fracture efficacy of several osteoporosis therapies, including a more stringent assessment of the ITT populations. Data on non-vertebral anti-fracture efficacy, a defined endpoint of the ITT analyses and confirmed by radiographs, were obtained from randomized, placebo-controlled, phase III clinical trials of at least 3-year duration. Meta-analyses were performed for the two bisphosphonates, alendronate and risedronate. Relative risks (RR), 95% confidence intervals (CI) and statistical significance for active treatment compared with placebo were calculated. Eleven clinical trials met the criteria for review, three of which showed statistically significant ( P < or =0.05) non-vertebral anti-fracture efficacy in the ITT population: two trials with risedronate and one trial with strontium. A meta-analysis showed significant reductions in the relative risk of non-vertebral fracture for both alendronate (RR=0.86; 95% CI: 0.76-0.97, P =0.012) and risedronate (RR=0.81; 95% CI: 0.71-0.92, P =0.001). Risedronate and strontium ranelate were the only treatments to show non-vertebral anti-fracture efficacy in this robust assessment of anti-fracture efficacy of osteoporosis therapy using ITT populations in trials of 3 years or more in duration. Risedronate was the only agent shown to demonstrate efficacy in more than one trial. Meta-analysis showed that both alendronate and risedronate provide non-vertebral anti-fracture efficacy.

Aged↗

PubMed1992

Meta-analysis for 2 x 2 tables: a Bayesian approach.

This paper develops and implements a fully Bayesian approach to meta-analysis, in which uncertainty about effects in distinct but comparable studies is represented by an exchangeable prior distribution. Specifically, hierarchical normal models are used, along with a parametrization that allows a unified approach to deal easily with both clinical trial and case-control study data. Monte Carlo methods are used to obtain posterior distributions for parameters of interest, integrating out the unknown parameters of the exchangeable prior or 'random effects' distribution. The approach is illustrated with two examples, the first involving a data set on the effect of beta-blockers after myocardial infarction, and the second based on a classic data set comprising 14 case-control studies on the effects of smoking on lung cancer. In both examples, rather different conclusions from those previously published are obtained. In particular, it is claimed that widely used methods for meta-analysis, which involve complete pooling of 'O-E' values, lead to understatement of uncertainty in the estimation of overall or typical effect size.

Adrenergic beta-Antagonists↗

PubMed2006

Processed meat consumption and stomach cancer risk: a meta-analysis.

BACKGROUND: The relationship between processed meat consumption and the risk of stomach cancer is controversial. We conducted a meta-analysis to summarize available evidence from cohort and case-control studies on this issue. METHODS: We searched Medline for studies of processed meat consumption and stomach cancer published from January 1966 through March 2006. Random-effects models were used to pool the relative risks from individual studies. All statistical tests were two-sided. RESULTS: Six prospective cohort studies (involving 2209 stomach cancer patients) and nine case-control studies (2495 case patients) were eligible for inclusion in the dose-response meta-analysis of processed meat consumption. The estimated summary relative risks of stomach cancer for an increase in processed meat consumption of 30 g/day, approximately half of an average serving, were 1.15 (95% confidence interval [CI] = 1.04 to 1.27) for the cohort studies and 1.38 (95% CI = 1.19 to 1.60) for the case-control studies. There was no statistically significant heterogeneity among the cohort studies (P = .42) or among the case-control studies (P = .19). In three cohort and four case-control studies that examined the association between bacon consumption and stomach cancer, the summary relative risk was 1.37 (95% CI = 1.17 to 1.61) for the highest versus lowest intake categories of bacon, without heterogeneity among these studies (P = .66). CONCLUSION: Increased consumption of processed meat is associated with an increased risk of stomach cancer. However, the possibility that the association may be confounded or modified by other factors cannot be ruled out.

Adult↗

PubMed1995

Methods used in studies of drink-drive control efforts: a meta-analysis of the literature from 1960 to 1991.

We searched the drink-drive control literature over the past three decades, finding over six thousand documents. After detailed review of the abstracts and papers, 125 studies contained separate empirical evaluations of the effects of 12 DWI control policies and enforcement efforts (administrative license suspension, illegal per se, implied consent, preliminary breath test, mandatory jail sentence, mandatory community service, mandatory license suspension, limits on plea bargaining, mandatory fines, selective enforcement patrols, regular police patrols, and sobriety checkpoints). The 125 studies contained 664 distinct analyses that formed the basis for meta-analysis. All of the DWI control efforts were associated with reductions in drink-driving and traffic crashes. The DWI control literature is limited by the preponderance of weak study designs and reports that often fail to include basic data required for meta-analysis. Because of the poor quality of much extant research, we were limited to simple gain scores or percent change estimates in the current study. Further research that does not include appropriate research designs and analytic methods will be of limited utility. We recommend that all future reports include effect estimates and standard error estimates, minimum data required for effective meta-analysis.

Accidents, Traffic↗

PubMed1996

A meta-analysis of studies on the safety and efficacy of aminoglycosides given either once daily or as divided doses.

We performed a meta-analysis of randomised clinical studies in which the efficacy and toxicity of the same total daily dose of aminoglycosides administered once-daily was compared with multiple divided daily dosing for treating human infections. Of twenty-eight publications identified from a literature search using Medline 19 publications of 20 study comparisons involving 2881 patients met the criteria for analysis. Netilmicin was investigated in 11 studies, amikacin in seven studies and gentamicin in two studies but no studies of tobramycin met the inclusion criteria. The meta-analysis showed that there was a small, statistically significant difference in clinical efficacy of 3.5% (95% confidence intervals 0.5% to 6.5%, P = 0.027) in favour of once-daily administration but no significant differences in bacteriological efficacy or nephrotoxicity were detected. Auditory and vestibular toxicity rates were low for all agents and no differences in these toxicities were identified between once-daily or multiple-dose administration regimens either clinically or by audiometry or electronystagmography. Aminoglycosides can be given once-daily without loss of efficacy or increased toxicity offering greater simplicity and potentially improved cost-effectiveness than can be achieved by giving these drugs in divided doses.

Aminoglycosides↗

PubMedDate not supplied

Cigarette smoking and cervical cancer: meta-analysis and critical review of recent studies.

The objective of this study is to investigate the strength of the epidemiological evidence for a relationship between smoking and cervical cancer by analysis of recent literature. I conducted a meta-analysis of all eligible case-control studies published in English from 1977 to July 1990, with the primary intent of examining the relationship between smoking and cervical cancer. I identified nine eligible studies. Data pooled from eight studies using similar definitions for cervical cancer and classification of smoking showed a significant effect on cervical cancer of ever having smoked, with a crude odds ratio (OR) of 1.46 (95% confidence interval [CI] 1.34-1.58). And, from those studies which adjusted for age and number of sexual partners, a weighted OR of 1.42 (95% CI 1.33-1.51) was obtained. A significant association between smoking and cervical cancer emerges. Data from these studies suggest a 42%-46% increase in cervical cancer among smokers, even after controlling for age and number of sexual partners.

Adult↗

PubMed1991

An examination of research design effects on the association of testosterone and male aging: results of a meta-analysis.

The study of testosterone is likely to be prominent in future epidemiological work on endocrine function and the clinical treatment of age-related diseases. Thus, understanding the hormonal changes involved in the normal male aging process will be critical. Using techniques of meta-analysis, the authors examined 88 published studies of the age-testosterone relation in men. These studies reported conflicting results: age-testosterone correlations ranged from -0.68 to +0.68. In cross-study comparisons, certain research design characteristics (e.g. time of day of blood sampling) and various sample characteristics (e.g. volunteers vs patients as subjects) were related to both mean testosterone level and the slope of the age-testosterone relation. For example, for subgroups of subjects that did not exclude ill men, the mean testosterone levels were low, and did not decline with age. Subgroups that included only healthy subjects, in contrast, had higher overall testosterone levels and showed a decline of testosterone with age. Implications of these results for design, analysis and reporting of future epidemiologic studies will be discussed. These results also illustrate the utility of meta-analysis for research with the aged.

Adult↗

PubMed2003

Meta analysis of risk factors for colorectal cancer.

AIM: To study the risk factors for colorectal cancer in China. METHODS: A meta-analysis of the risk factors of colorectal cancer was conducted for 14 case-control studies, and reviewed 14 reports within 13 years which included 5034 cases and 5205 controls. Dersimonian and Laird random effective models were used to process the results. RESULTS: Meta analysis of the 14 studies demonstrated that proper physical activities and dietary fibers were protective factors (pooled OR<0.8), while fecal mucohemorrhage, chronic diarrhea and polyposis were highly associated with colorectal cancer (all pooled OR>4). The stratified results showed that different OR values of some factors were due to geographic factors or different resources. CONCLUSION: Risks of colorectal cancer are significantly associated with the histories of intestinal diseases or relative symptoms, high lipid diet, emotional trauma and family history of cancers. The suitable physical activities and dietary fibers are protective factors.

Case-Control Studies↗

PubMed1998

Meta-analysis about efficacy of anti-resorptive drugs in post-menopausal osteoporosis.

OBJECTIVE: The purpose of this study was to compare the effect of three groups of anti-resorptive drugs in post-menopausal osteoporosis. DATA SOURCES: We collected data covering the period between 1983 and 1995, by first using MEDLINE. References retrieved were scanned further to identify additional papers. STUDY SELECTION: Only randomized studies evaluating bone mass by means of dual-photon or dual energy densitometry over a period of 1 year were accepted. DATA EXTRACTION: Studies were arranged into three drug groups. We used densitometry results after 1 year in all treatment or control groups. Factors which might interfere with the results were recorded for subsequent separate analysis. DATA SYNTHESIS: The MEDLINE search identified almost 25,000 studies. On reading the abstracts, 275 trials appeared to be controlled trials and original copies were retrieved for detailed analysis. A total of 31 articles which satisfied the inclusion criteria were identified. The first meta-analysis included studies which compared oestrogens and placebo, and the global effect-size was 0.54 (95% CI 0.34, 0.73). The second meta-analysis compared calcitonins with placebo and produced an effect-size of 0.41 (95% CI 0.21, 0.61) The third analysis compared bisphosphonates and placebo and showed an effect-size of 0.87 (95% CI 0.68, 1.07). Only oestrogen dose affected the results found. CONCLUSIONS: Bisphosphonates had the greatest effect on bone mass in post-menopausal osteoporosis.

Bone Resorption↗

PubMed2001

Dose-response relation of inhaled fluticasone propionate in adolescents and adults with asthma: meta-analysis.

OBJECTIVE: To examine the dose-response relation of inhaled fluticasone propionate in adolescents and adults with asthma. DESIGN: Meta-analysis of placebo controlled, randomised clinical trials that presented data on at least one outcome measure of asthma and that used at least two different doses of fluticasone. SETTING: Medline, Embase, and GlaxoWellcome's internal clinical study registers. MAIN OUTCOME MEASURES: FEV(1), morning and evening peak expiratory flow, night awakenings, beta agonist use, and major exacerbations. RESULTS: Eight studies, with 2324 adolescents and adults with asthma, met the inclusion criteria. Data on doses of >500 microg/day were limited. The dose-response curve for the raw data began to reach a plateau at around 100-200 microg/day and peaked by 500 microg/day. A negative exponential model for the data, without meta-analysis, indicated that 80% of the benefit at 1000 microg/day was achieved at doses of 70-170 microg/day and 90% by 100-250 microg/day. A quadratic meta-regression showed that the maximum achievable efficacy was obtained by doses of around 500 microg/day. The odds ratio for patients remaining in a study at a dose of 200 microg/day, compared with higher doses, was 0.73 (95% confidence interval 0.49 to 1.08). Comparison of the standardised difference in FEV(1 )for an inhaled dose of 200 microg/day against higher doses showed a difference in FEV(1) of 0.13 of a standard deviation (-0.02 to 0.29). CONCLUSIONS: In adolescent and adult patients with asthma, most of the therapeutic benefit of inhaled fluticasone is achieved with a total daily dose of 100-250 microg, and the maximum effect is achieved with a dose of around 500 microg/day. However, these findings were limited by the lack of data on individual patients and by the paucity of dose-response studies that included doses of >500 microg/day.

Administration, Inhalation↗

PubMed2001

Esthesioneuroblastoma: a meta-analysis and review.

Our objective was to review recent developments in diagnosis, staging, and treatment of esthesioneuroblastoma (ENB). A meta-analysis of publications between 1990 and 2000 was carried out, and studies were classified according to their main subject: origin/aetiology of ENB, histopathological diagnosis, and treatment. Data so far point to the basal progenitor cells of the olfactory epithelium as the origin of ENB. Histopathological diagnosis remains difficult and is based on results of antigen expression detected through a panel of antibodies by immunohistochemistry. RT-PCR of HASH expression could be a specific marker of ENB. Overall and disease-free survival at 5 years averaged 45% (SD 22) and 41% (SD 21) in the studies included in the meta-analysis. Survival in Hyams' grades I-II was 56% (SD 20) compared with 25% (SD 20) in grades III-IV (odds ratio 6.2). In patients with metastases in cervical lymph nodes (on average 5% of the total) survival was 29%, compared with 64% for patients with N0 disease (odds ratio 5.1). Survival according to treatment modalities was 65% for surgery plus radiotherapy, 51% for radiotherapy and chemotherapy, 48% for surgery, 47% for surgery plus radiotherapy and chemotherapy, and 37% for radiotherapy alone. The histopathological grading according to Hyams and the presence of cervical lymph-node metastases emerged as prognostic factors. A combination of surgery and radiotherapy seems to be the optimum approach to treatment. The exact role of chemotherapy in treatment protocols is still unclear. The role of elective neck dissection is unclear.

Esthesioneuroblastoma, Olfactory↗

PubMed2006

Toward understanding the genetics of alcohol drinking through transcriptome meta-analysis.

Much evidence from studies in humans and animals supports the hypothesis that alcohol addiction is a complex disease with both hereditary and environmental influences. Molecular determinants of excessive alcohol consumption are difficult to study in humans. However, several rodent models show a high or low degree of alcohol preference, which provides a unique opportunity to approach the molecular complexities underlying the genetic predisposition to drink alcohol. Microarray analyses of brain gene expression in three selected lines, and six isogenic strains of mice known to differ markedly in voluntary alcohol consumption provided >4.5 million data points for a meta-analysis. A total of 107 arrays were obtained and arranged into six experimental data sets, allowing the identification of 3,800 unique genes significantly and consistently changed between all models of high or low amounts of alcohol consumption. Several functional groups, including mitogen-activated protein kinase signaling and transcription regulation pathways, were found to be significantly overrepresented and may play an important role in establishing a high level of voluntary alcohol drinking in these mouse models. Data from the general meta-analysis was further filtered by a congenic strain microarray set, from which cis-regulated candidate genes for an alcohol preference quantitative trait locus on chromosome 9 were identified: Arhgef12, Carm1, Cryab, Cox5a, Dlat, Fxyd6, Limd1, Nicn1, Nmnat3, Pknox2, Rbp1, Sc5d, Scn4b, Tcf12, Vps11, and Zfp291 and four ESTs. The present study demonstrates the use of (i) a microarray meta-analysis to analyze a behavioral phenotype (in this case, alcohol preference) and (ii) a congenic strain for identification of cis regulation.

Alcohol Drinking↗

PubMed2004

Vascular complications associated with arteriotomy closure devices in patients undergoing percutaneous coronary procedures: a meta-analysis.

OBJECTIVES: This study was designed to assess the safety of arteriotomy closure devices (ACDs) versus mechanical compression by meta-analysis in patients undergoing percutaneous transfemoral coronary procedures. BACKGROUND: Although ACDs are widely applied for hemostasis after percutaneous endovascular procedures, their safety is controversial. METHODS: Randomized, case-control, and cohort studies comparing access-related complications using ACDs versus mechanical compression were analyzed. The primary end point was the cumulative incidence of vascular complications, including pseudoaneurysm, arteriovenous fistula, retroperitoneal hematoma, femoral artery thrombosis, surgical vascular repair, access site infection, and blood transfusion. RESULTS: A total of 30 studies involving 37,066 patients were identified. No difference in complication incidence between Angio-Seal and mechanical compression was revealed in the diagnostic (Dx) setting (odds ratio [OR] 1.08, 95% confidence interval [CI] 0.11 to 10.0) or percutaneous coronary interventions (PCI) (OR 0.86, 95% CI 0.65 to 1.12). Meta-analysis of randomized trials only showed a trend toward less complications using Angio-Seal in a PCI setting (OR 0.46, 95% CI 0.20 to 1.04; p = 0.062). No differences were observed regarding Perclose in either Dx (OR 1.51, 95% CI 0.24 to 9.47) or PCI (OR 1.21, 95% CI 0.94 to 1.54) setting. An increased risk in complication rates using VasoSeal in the PCI setting (OR 2.25, 95% CI 1.07 to 4.71) was found. The overall analysis favored mechanical compression over ACD (OR 1.34, 95% CI 1.01 to 1.79). CONCLUSIONS: In the setting of Dx angiography, the risk of access-site-related complications was similar for ACD compared with mechanical compression. In the setting of PCI, the rate of complications appeared higher with VasoSeal.

Angioplasty, Balloon, Coronary↗

PubMed1993

Controversies in meta-analysis: the case of the trials of serum cholesterol reduction.

There has recently been disagreement in the literature on the results and interpretation of meta-analyses of the trials of serum cholesterol reduction, both in terms of the quantification of the effect on ischaemic heart disease and as regards the evidence of any adverse effect on other causes of death. This paper describes statistical aspects of a recent meta-analysis of these trials, and draws some more general conclusions about the methods used in meta-analysis. Tests of an overall null hypothesis are shown to have a basis clearly distinct from the more extensive assumptions needed to provide an overall estimate of effect. The fixed effect approach to estimation relies on the implausible assumption of homogeneity of treatment effects across the trials, and is therefore likely to yield confidence intervals which are too narrow and conclusions which are too dogmatic. However the conventional random effects method relies on its own set of unrealistic assumptions, and cannot be regarded as a robust solution to the problem of statistical heterogeneity. The random effects method is more usefully regarded as a type of sensitivity analysis in which the weights allocated to each study in estimating the overall effect are modified. However, rather than using a statistical model for the 'unexplained' heterogeneity, greater insight and scientific understanding of the results of a set of trials may be obtained by a careful exploration of potential sources of heterogeneity. In the context of the cholesterol trials, the heterogeneity according to the extent and duration of cholesterol reduction are of prime concern and are investigated using logistic regression. It is concluded that the long-term benefits of serum cholesterol reduction on the risk of heart disease have been seriously underestimated in some previous meta-analyses, while the evidence for adverse effects on other causes of death have been misleadingly exaggerated.

Cholesterol↗

PubMed2003

Relevance of micrometastases detected by reverse transcriptase-polymerase chain reaction for melanoma recurrence: systematic review and meta-analysis.

CONTEXT: Cutaneous melanoma presents significant morbidity and mortality. Nowadays, about 90% of them are diagnosed by clinical examination and most are localized melanomas. Sentinel node biopsy has brought about a new and interesting approach towards localized cutaneous melanoma. The meaning of micrometastases in sentinel nodes diagnosed by the reverse transcriptase-polymerase chain reaction is not well established. OBJECTIVE: To define the real value of micrometastases diagnosed by the reverse transcriptases polymerase chain reaction in relation to melanoma recurrence. METHODS: Systematic literature review and meta-analysis. The Cochrane Library, Medline, Embase and Lilacs were the databases searched. We used the following key words: sentinel node and melanoma; sentinel node and reverse transcriptase-polymerase chain reaction; melanoma and reverse transcriptase-polymerase chain reaction. Cohort studies enrolling localized cutaneous melanoma patients who underwent sentinel node biopsy were selected. Sentinel node evaluations included hematoxylin and eosin, immunohistochemistry and reverse transcriptase-polymerase chain reaction. RESULTS: Out of the 1,542 studies evaluated, four were eligible. The four studies, when combined, were statistically homogeneous. The sample totaled 450 patients grouped as follows: 163 with a sentinel node negative to hematoxylin eosin and immunohistochemistry and positive to the reverse transcriptase-polymerase chain reaction; 192 with a sentinel node negative to hematoxylin eosin, immunohistochemistry and the reverse transcriptase-polymerse chain reaction and 95 patients with a sentinel node positive to hematoxylin eosin and/or immunohistochemistry. We analyzed the first two groups. The meta-analysis for the random model showed an increased effect from a positive reverse transcriptase-polymerase chain reaction on the recurrence rate. A similar result occurred in the meta-analysis for the fixed effect model. CONCLUSION: Patients with a positive reverse transcriptase-polymerase chain reaction had a greater recurrence rate than those with a negative reverse transcriptase-polymerase chain reaction. This suggests an important role for the reverse transcriptase-polymerase chain reaction in sentinel node examinations. In view of the small sample, a clinical trial could better evaluate this question.

Humans↗

PubMed1995

Final results from a meta-analysis of remedial interventions with drink/drive offenders.

A meta-analysis of the efficacy of remediation with drinking/driving offenders included 215 independent evaluations identified through a comprehensive literature search. Study characteristics, including dimensions of methodological quality were coded using scales and protocols developed by expert panels. Better methodological quality (as indicated by group equivalence) was associated with smaller effect size and less variation in effect size. Among studies with adequate methods (as determined empirically through examination of effect size variation with quality), the average effect of remediation on drinking/driving recidivism was an 8-9% reduction over no remediation. A similar effect size was found for alcohol involved crashes. However, licensing actions tended to be associated with reduction in occurrence of non-alcohol events (e.g. non-alcohol crashes). Exploratory regression analysis and confirmatory within study analysis suggested that combinations of modalities--in particular those including education, psychotherapy/counseling and follow-up contact/probation--were more effective than other evaluated modes for reducing drinking/driving recidivism. Treatment effects are probably underestimated in the literature due to overemphasis on education as a treatment for all offenders and drinking/driving recidivism as the most frequent measure of outcome. Limitations of the primary literature and future research needs are discussed.

Accidents, Traffic↗

PubMed2005

Association between the current use of low-dose oral contraceptives and cardiovascular arterial disease: a meta-analysis.

CONTEXT: The long-term cardiovascular safety of widely used oral contraceptives (OCs) is still debated, and no meta-analysis assesses the modern use of OCs and the associated cardiovascular risks. OBJECTIVE: We aimed to assess the risk of cardiovascular diseases associated with current use of low-dose combined OCs. DATA SOURCES: All studies published between January 1980 and October 2002 were searched using MEDLINE, BIOSIS, and Scientific Citations. STUDY SELECTION: Original studies were selected independently by two investigators (J.P.B., P.A.E.) based on inclusion criteria: low-dose combined OC (<50 mug of ethinyl-estradiol); more than 10 cases in low-dose users; clear definition of cases; concurrent controls; and control for age. A third investigator (J.E.N.) adjudicated disagreements. From 2715 identified articles, 14 independent studies were included. DATA EXTRACTION: All data were abstracted by one investigator (J.P.B.) in a systematic manner. Classification of OCs and types of exposure were directly abstracted from studies. Current use was defined as use at the time of the event or within 3 months. Only peer-reviewed studies with definition of events as definite or possible, based on prespecified criteria, were included. DATA SYNTHESIS: The summary risk estimates associated with current use of low-dose OCs were 1.84 [95% confidence interval (CI) = 1.38, 2.44] for myocardial infarctions and 2.12 (95% CI = 1.56, 2.86) for ischemic strokes. The overall summary odds ratio for both outcomes was 2.01 (95% CI = 1.63, 2.48). Second generation OCs were associated with a significant increased risk of both myocardial infarction and ischemic stroke events [1.85 (95% CI = 1.03,3.32) and 2.54 (95% CI = 1.96,3.28), respectively]; and third-generation OCs, for ischemic stroke outcome only [2.03 (95% CI = 1.15,3.57)]. CONCLUSIONS: In conclusion, a rigorous meta-analysis of the literature suggests that current use of low-dose OCs significantly increases the risk of both cardiac and vascular arterial events, including a significant risk of vascular arterial complications with third generation OCs.

Brain Ischemia↗