Postmenopausal Hormone Therapy and Stroke Risk
Are oral and transdermal estrogens or progesterone associated with increased stroke risk?
This was a nested case-control study of ischemic stroke. The study population included all French women ages 51-62 years without a prior history of cardiovascular disease or a contraindication to hormonal therapy. Data were collected between the years 2009 and 2011. Women were identified through the French National Health Insurance database and French National hospital data.
A total of 3,144 women were identified as cases (hospitalized with ischemic stroke). A total of 12,158 controls were identified and matched to the cases by age and zip code. Women who used oral estrogen had an increased risk for ischemic stroke (odds ratio [OR], 1.58; 95% CI, 1.01-2.49) compared to nonusers. No significant difference was observed for women using transdermal estrogens compared to nonusers (OR, 0.83; 95% CI, 0.56-1.24). No association between ischemic stroke and use of progesterone (OR, 0.78; 95% CI, 0.49-1.26), pregnanes (OR, 1.00; 95% CI, 0.60-1.67), and nortestosterones (OR, 1.26; 95% CI, 0.62-2.58) was observed, while norpregnanes was associated with an increased risk of ischemic stroke (OR, 2.25; 95% CI, 1.05-4.81).
The investigators concluded that both route of estrogen administration and progestogens were important determinants of ischemic stroke. These data suggest that transdermal estrogens might be the safest option for short-term hormone therapy use.
These data assist clinicians in discussing the options for hormonal therapy with women. Numerous choices exist for estrogen and progesterone. Studies such as this one help inform patients (and providers) regarding the risk for cardiovascular events such as ischemic stroke.
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