Abstract 50: Oral Contraceptive Use and Incident Stroke in Women With Sickle Cell Disease

Background: Oral contraceptives increase the risk of ischemic stroke among women. However, the effect is not studied in the stroke prone sickle cell disease population. Objective: To determine the rate of incident stroke among women with sickle cell disease enrolled a large cohort with longitudinal follow-up. Methods: A total of 1263 women aged ≥15 and <45 years, were enrolled in Phase 1 of Cooperative Study of Sickle Cell Disease from 23 centers across the US. Participants underwent a baseline examination for assessment of demographics, prior medical history, lab assessments, and clinical data. Post baseline data included routine follow-up examinations, measures of organ damage, and collection of acute and chronic complications. The effect of oral contraceptive use on incident stroke were assessed after adjusting for age, cigarette smoking, and history of exchange transfusion by Cox Proportional Hazards analysis. Results: A total of 281 (22.2%) of 1263 women with sickle cell disease reported use of oral contraceptives. There was no difference in the mean age (±SD) of the women who reported use compared with those without of oral contraceptives (27 ±6 versus 27±8, p=0.9). History of exchange transfusions (24.2 % versus 15.0 %, p=0.003) and cigarette smoking (24.7 % versus 18.5 %, p=0.03) were more common among women who report use of oral contraceptives. The age adjusted annual incidence of incident stroke among women who used oral contraceptives was four folds higher than those who did not report use (1.4% versus 0.3%, p= 0.04). After adjusting for exchange transfusion and cigarette smoking, oral contraceptive use was not associated with rate of ischemic stroke (HR, 0.3 95% CI 0.06-1.3, p= 0.2) or stroke free survival (HR, 0.98 95% CI 0.6-1.6, p= 0.9). Conclusions: The four fold higher risk of incident stroke associated with use of oral contraceptives in women with sickle cell disease can be mitigated by avoiding cigarette smoking.

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