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(Circulation. 2001;103:638.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Postmenopausal Hormone Therapy and Risk of Stroke
The Heart and Estrogen-progestin Replacement Study (HERS)
From the General Internal Medicine Section, Medical Service, Veterans Affairs Medical Center (J.A.S.), San Francisco, Calif; Division of Clinical Research, Department of Epidemiology and Biostatistics, School of Medicine, University of California (J.A.S., F.H., J.F., S.B.H.), San Francisco, Calif; Department of Medicine, George Washington University (J.H.), Washington, DC; Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh (J.A.C.), Pittsburgh, Pa; Wyeth-Ayerst Research (C.R.), Radnor, Pa; Department of Family Medicine and Preventive Medicine, School of Medicine, University of California (E.B.-C.), San Diego.
Correspondence to Dr Joel A. Simon, General Internal Medicine (111A1), San Francisco VA Medical Center, 4150 Clement St, San Francisco, CA 94121. E-mail jasimon{at}itsa.ucsf.edu
Background—Observational studies have shown that postmenopausal hormone therapy may increase, decrease, or have no effect on the risk of stroke. To date, no clinical trial has examined this question. To investigate the relation between estrogen plus progestin therapy and risk of stroke among postmenopausal women, we analyzed data collected from the Heart & Estrogen-progestin Replacement Study (HERS), a secondary coronary heart disease prevention trial.
Methods and Results—Postmenopausal women (n=2763) were randomly assigned to take conjugated estrogen plus progestin or placebo. Primary outcomes for these analyses were stroke incidence and stroke death during a mean follow-up of 4.1 years. The number of women with strokes was compared with the number of women without strokes. A total of 149 women (5%) had 1 or more strokes, 85% of which were ischemic, resulting in 26 deaths. Hormone therapy was not significantly associated with risk of nonfatal stroke (relative hazard [RH] 1.18; 95% CI 0.83 to 1.66), fatal stroke (RH 1.61; 95% CI 0.73 to 3.55), or transient ischemic attack (RH 0.90; 95% CI 0.57 to 1.42). Independent predictors of stroke events included increasing age, hypertension, diabetes, current cigarette smoking, and atrial fibrillation. Black women were at increased risk compared with white women, and unexpectedly, body mass index was inversely associated with stroke risk.
Conclusions—Hormone therapy with conjugated equine estrogen and progestin had no significant effect on the risk for stroke among postmenopausal women with coronary disease.
Key Words: cerebrovascular disorders • hormones • stroke
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