Hormone replacement therapy and associated risk of stroke in postmenopausal women

Rozenn N. Lemaitre, Susan R. Heckbert, Bruce M. Psaty, Nicholas L. Smith, Robert C. Kaplan, W. T. Longstreth

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

Background: There is little information about the risk of stroke in relation to time since initiation of hormone therapy and in relation to estrogen dose. Methods: We conducted a population-based case-control study at Group Health Cooperative (GHC), a health maintenance organization in the greater Seattle (Wash) area, to assess the association of hormone replacement therapy with the risks of incident ischemic and hemorrhagic stroke. Cases were all postmenopausal women with incident stroke at GHC during July 1989 through December 1998 (726 ischemic strokes and 213 hemorrhagic strokes). Controls were randomly selected from GHC enrollees and frequency matched to cases on age and calendar year (n = 2525). Hormone use was assessed from computerized pharmacy data. We reviewed the medical record to confirm eligibility and assess other risk factors. Results: After risk factor adjustment, ischemic stroke was not associated with current use of estrogen with progestin (odds ratio [95% confidence interval]: 0.97 [0.69-1.37]) or without (0.94[0.72-1.23]) compared with never use. Similarly, hemorrhagic stroke was not associated with current use of estrogen with progestin (0.74 [0.43-1.28]) or without (1.06[0.71-1.56]). However, the risks of ischemic stroke and hemorrhagic stroke were increased 2-fold during the first 6 months of hormone use (ischemic stroke: 2.16[1.04-4.49], hemorrhagic stroke: 2.20 [0.83-5.81]). Risk of ischemic stroke also increased with estrogen dose (P for trend=.03). Conclusion: The transitory increase in risks of ischemic stroke and hemorrhagic stroke associated with initiation of hormone replacement therapy merits further investigation.

Original languageEnglish (US)
Pages (from-to)1954-1960
Number of pages7
JournalArchives of Internal Medicine
Volume162
Issue number17
DOIs
StatePublished - Sep 23 2002
Externally publishedYes

Fingerprint

Hormone Replacement Therapy
Stroke
Estrogens
Hormones
Progestins
Health
Risk Adjustment
Health Maintenance Organizations
Medical Records
Case-Control Studies

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Lemaitre, R. N., Heckbert, S. R., Psaty, B. M., Smith, N. L., Kaplan, R. C., & Longstreth, W. T. (2002). Hormone replacement therapy and associated risk of stroke in postmenopausal women. Archives of Internal Medicine, 162(17), 1954-1960. https://doi.org/10.1001/archinte.162.17.1954

Hormone replacement therapy and associated risk of stroke in postmenopausal women. / Lemaitre, Rozenn N.; Heckbert, Susan R.; Psaty, Bruce M.; Smith, Nicholas L.; Kaplan, Robert C.; Longstreth, W. T.

In: Archives of Internal Medicine, Vol. 162, No. 17, 23.09.2002, p. 1954-1960.

Research output: Contribution to journalArticle

Lemaitre, RN, Heckbert, SR, Psaty, BM, Smith, NL, Kaplan, RC & Longstreth, WT 2002, 'Hormone replacement therapy and associated risk of stroke in postmenopausal women', Archives of Internal Medicine, vol. 162, no. 17, pp. 1954-1960. https://doi.org/10.1001/archinte.162.17.1954
Lemaitre, Rozenn N. ; Heckbert, Susan R. ; Psaty, Bruce M. ; Smith, Nicholas L. ; Kaplan, Robert C. ; Longstreth, W. T. / Hormone replacement therapy and associated risk of stroke in postmenopausal women. In: Archives of Internal Medicine. 2002 ; Vol. 162, No. 17. pp. 1954-1960.
@article{13bf09721f1a4f8a8a43b5259a7a76c7,
title = "Hormone replacement therapy and associated risk of stroke in postmenopausal women",
abstract = "Background: There is little information about the risk of stroke in relation to time since initiation of hormone therapy and in relation to estrogen dose. Methods: We conducted a population-based case-control study at Group Health Cooperative (GHC), a health maintenance organization in the greater Seattle (Wash) area, to assess the association of hormone replacement therapy with the risks of incident ischemic and hemorrhagic stroke. Cases were all postmenopausal women with incident stroke at GHC during July 1989 through December 1998 (726 ischemic strokes and 213 hemorrhagic strokes). Controls were randomly selected from GHC enrollees and frequency matched to cases on age and calendar year (n = 2525). Hormone use was assessed from computerized pharmacy data. We reviewed the medical record to confirm eligibility and assess other risk factors. Results: After risk factor adjustment, ischemic stroke was not associated with current use of estrogen with progestin (odds ratio [95{\%} confidence interval]: 0.97 [0.69-1.37]) or without (0.94[0.72-1.23]) compared with never use. Similarly, hemorrhagic stroke was not associated with current use of estrogen with progestin (0.74 [0.43-1.28]) or without (1.06[0.71-1.56]). However, the risks of ischemic stroke and hemorrhagic stroke were increased 2-fold during the first 6 months of hormone use (ischemic stroke: 2.16[1.04-4.49], hemorrhagic stroke: 2.20 [0.83-5.81]). Risk of ischemic stroke also increased with estrogen dose (P for trend=.03). Conclusion: The transitory increase in risks of ischemic stroke and hemorrhagic stroke associated with initiation of hormone replacement therapy merits further investigation.",
author = "Lemaitre, {Rozenn N.} and Heckbert, {Susan R.} and Psaty, {Bruce M.} and Smith, {Nicholas L.} and Kaplan, {Robert C.} and Longstreth, {W. T.}",
year = "2002",
month = "9",
day = "23",
doi = "10.1001/archinte.162.17.1954",
language = "English (US)",
volume = "162",
pages = "1954--1960",
journal = "JAMA Internal Medicine",
issn = "2168-6106",
publisher = "American Medical Association",
number = "17",

}

TY - JOUR

T1 - Hormone replacement therapy and associated risk of stroke in postmenopausal women

AU - Lemaitre, Rozenn N.

AU - Heckbert, Susan R.

AU - Psaty, Bruce M.

AU - Smith, Nicholas L.

AU - Kaplan, Robert C.

AU - Longstreth, W. T.

PY - 2002/9/23

Y1 - 2002/9/23

N2 - Background: There is little information about the risk of stroke in relation to time since initiation of hormone therapy and in relation to estrogen dose. Methods: We conducted a population-based case-control study at Group Health Cooperative (GHC), a health maintenance organization in the greater Seattle (Wash) area, to assess the association of hormone replacement therapy with the risks of incident ischemic and hemorrhagic stroke. Cases were all postmenopausal women with incident stroke at GHC during July 1989 through December 1998 (726 ischemic strokes and 213 hemorrhagic strokes). Controls were randomly selected from GHC enrollees and frequency matched to cases on age and calendar year (n = 2525). Hormone use was assessed from computerized pharmacy data. We reviewed the medical record to confirm eligibility and assess other risk factors. Results: After risk factor adjustment, ischemic stroke was not associated with current use of estrogen with progestin (odds ratio [95% confidence interval]: 0.97 [0.69-1.37]) or without (0.94[0.72-1.23]) compared with never use. Similarly, hemorrhagic stroke was not associated with current use of estrogen with progestin (0.74 [0.43-1.28]) or without (1.06[0.71-1.56]). However, the risks of ischemic stroke and hemorrhagic stroke were increased 2-fold during the first 6 months of hormone use (ischemic stroke: 2.16[1.04-4.49], hemorrhagic stroke: 2.20 [0.83-5.81]). Risk of ischemic stroke also increased with estrogen dose (P for trend=.03). Conclusion: The transitory increase in risks of ischemic stroke and hemorrhagic stroke associated with initiation of hormone replacement therapy merits further investigation.

AB - Background: There is little information about the risk of stroke in relation to time since initiation of hormone therapy and in relation to estrogen dose. Methods: We conducted a population-based case-control study at Group Health Cooperative (GHC), a health maintenance organization in the greater Seattle (Wash) area, to assess the association of hormone replacement therapy with the risks of incident ischemic and hemorrhagic stroke. Cases were all postmenopausal women with incident stroke at GHC during July 1989 through December 1998 (726 ischemic strokes and 213 hemorrhagic strokes). Controls were randomly selected from GHC enrollees and frequency matched to cases on age and calendar year (n = 2525). Hormone use was assessed from computerized pharmacy data. We reviewed the medical record to confirm eligibility and assess other risk factors. Results: After risk factor adjustment, ischemic stroke was not associated with current use of estrogen with progestin (odds ratio [95% confidence interval]: 0.97 [0.69-1.37]) or without (0.94[0.72-1.23]) compared with never use. Similarly, hemorrhagic stroke was not associated with current use of estrogen with progestin (0.74 [0.43-1.28]) or without (1.06[0.71-1.56]). However, the risks of ischemic stroke and hemorrhagic stroke were increased 2-fold during the first 6 months of hormone use (ischemic stroke: 2.16[1.04-4.49], hemorrhagic stroke: 2.20 [0.83-5.81]). Risk of ischemic stroke also increased with estrogen dose (P for trend=.03). Conclusion: The transitory increase in risks of ischemic stroke and hemorrhagic stroke associated with initiation of hormone replacement therapy merits further investigation.

UR - http://www.scopus.com/inward/record.url?scp=0037163479&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0037163479&partnerID=8YFLogxK

U2 - 10.1001/archinte.162.17.1954

DO - 10.1001/archinte.162.17.1954

M3 - Article

VL - 162

SP - 1954

EP - 1960

JO - JAMA Internal Medicine

JF - JAMA Internal Medicine

SN - 2168-6106

IS - 17

ER -