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HRT and Stroke Risk
Title:Hormone replacement therapy and risk of non-fatal stroke
Author:B.Ettinger et al.
Address:Copenhagen, Denmark
Source:Lancet 350: 1277-1283 (November) 1997
Summary:Stroke is the third leading cause of death among postmenopausal women in developed countries. The incidence rate of a first- ever stroke among women aged 45-64 years is 1-2 in 1000 per year. Postmenopausal hormone replacement therapy(HRT) demonstrates convincing evidence of a protective effect against coronary heart disease. The effect of HRT on the risk of stroke remains controversial. This study investigates the effect of estrogen and combined estrogen-progesterone therapy on the risk of non-fatal hemorrhagic and thromboembolic stroke. All Danish women aged 45-64 who had a non-fatal, first time cerebrovascular attack during 1990-1992 were identified. Two aged matched control s were randomly selected. Information on hormone use and stroke correlates gained from postal questionnaires were controlled for by multivariate analysis based on log-linear graphical models. 1422 cases were classified into 4 subtypes of strokes: 160 subarachnoid hemorrhage; 95 intracerebral hemorrhage; 846 thromboembolic infarction; and 321 transient ischemic attack. This was compared with 3171 controls. After confounding variables were adjusted for and pharmaceutical sale trends were corrected, no association could be made between unopposed estrogen therapy and subarachnoid hemorrhage (odds ratio 0.52[95%CI 0.23-1.22}), intracerebral hemorrhage(odds ratio 0.15[95%CI 0.02-1.09}), or thromboembolic infarction (odds ratio 1.16[95%CI 0.86-1.58}) compared with the never used HRT control group. Estrogen- progesterone HRT showed no statistical association withsubarachnoid hemorrhage (1.22[0.79-1.89}), intracerebral hemorrhage( 1.17 [ 0.64-2.13), or thromboembolic infarction (odds ratio 1.17 [95%CI 0.92-1.47}) . There was noted a significantly increased incidence of transient ischemic attacks among former HRT users and current users of estrogen only HRT. The authors explain this as HRT patients being more aware of symptoms than non HRT patients. The authors assert that there in no influence on the risk of non-fatal thromboembolic or hemorraghic stroke among women aged 45-64 on either unopposed estrogen or combination estrogen and progeatestone replacement therapy.
Comment:Forever , we have associated clots with estrogen and stroke with oral contraceptives. The confusion probably has arisen from varying responses related to the amount of steroid used and, that synthetic steroids are not the same as naturally occuring steroids. The above represents an important and reassuring study.