June 2009, Volume 11, Issue 3, pp 241-250
Date: 02 May 2009
Hormone therapy and stroke: Is it all about timing?
- Cheryl Bushnell
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Although women have a lower incidence of stroke than men in most age groups, women have an overall increased lifetime risk of stroke. Women also have unique risk factors for stroke, including the menopausal transition, the existence of debilitating vasomotor symptoms for some women, and the issues related to hormonal treatment for those symptoms. Although the initial studies of hormone therapy (HT) use in postmenopausal women suggested significant protection against heart disease, there was no obvious protection against stroke. Randomized trials of HT for secondary prevention showed a lack of benefit for both heart disease and stroke, and the suggestion of some early risk after initiation. However, the Women’s Health Initiative (WHI), a primary prevention study of the impact of HT on women aged 50 to 79 years, showed an increased risk of stroke, whether the HT was estrogen alone or estrogen combined with progestin. Therefore, HT is not recommended for stroke prevention, and it appears to cause harm. The reason for this increased stroke risk is not understood, but some have suggested that the initiation of HT closest to the time of menopausal transition should decrease the risk. Although there was a lower risk of heart disease when HT was initiated earlier, the risk appeared to be the same for stroke regardless of the timing. This was shown in both the WHI and the Nurses’ Health Study cohorts. Therefore, more research is needed to understand the mechanisms for the increased stroke risk and to identify those who may be at risk because of HT for vasomotor symptoms, atrophic vaginitis, or osteoporosis, the three remaining indications for HT use in women. Trials are under way to assess the intermediate outcomes of HT on subclinical vascular disease in perimenopausal/early postmenopausal women.
References and Recommended Reading
Grady D, Rubin SM, Petitti DB, et al.: Hormone therapy to prevent disease and prolong life in postmenopausal women. Ann Intern Med 1992, 117:1016–1037.PubMed
Petitti DB, Sidney S, Quesenberry CP Jr, Bernstein A: Ischemic stroke and use of estrogen and estrogen/progestogen as hormone replacement therapy. Stroke 1998, 29:23–28.PubMed
Pfeffer R, Van Den Noort S: Estrogen use and stroke risk in postmenopausal women. Am J Epidemiol 1976, 103:445–456.PubMed
Pederson AT, Lidegaard O, Kreiner S, Ottesen B: Hormone replacement therapy and risk of non-fatal stroke. Lancet 1997, 350:1277–1283.CrossRef
Wilson PW, Garrison RJ, Castelli WP: Postmenopausal estrogen use, cigarette smoking, and cardiovascular morbidity in women over 50. N Engl J Med 1985, 313:1038–1043.PubMed
Rosenberg SH, Fausone V, Clark R: The role of estrogens as a risk factor for stroke in postmenopausal women. West J Med 1980, 133:292–296.PubMed
Grodstein F, Manson JE, Colditz GA, et al.: A prospective, observational study of postmenopausal hormone therapy and primary prevention of cardiovascular disease. Ann Intern Med 2000, 133:922–941.
Lindenstrom E, Boysen G, Nyboe J: Lifestyle factors and risk of cerebrovascular disease in women: the Copenhagen City Heart Study. Stroke 1993, 24:1468–1472.PubMed
Simon JA, Hsia J, Cauley JA, et al.: Postmenopausal hormone therapy and risk of stroke. The Heart and Estrogen-progestin Replacement Study (HERS). Circulation 2001, 103:638–642.PubMed
Writing Group for the Women’s Health Initiative Investigators: Risks and benefits of estrogen plus progestin in healthy post-menopausal women. Principal results from the Women’s Health Initiative randomized controlled trial. JAMA 2002, 288:321–333.CrossRef
Breslau ES, Davis WW, Doner L, et al.: The hormone therapy dilemma: women respond. J Am Med Womens Assoc 2003, 58:33–43.PubMed
Bushnell CD, Goldstein LB: Risk of ischemic stroke with tamoxifen treatment for breast cancer: a meta-analysis. Neurology 2004, 63:1230–1233.PubMed
Barrett-Connor E, Mosca L, Collins P, et al.: Effects of raloxifene on cardiovascular events and breast cancer in postmenopausal women. N Eng J Med 2006, 355:125–137.CrossRef
ACOG Task Force for Hormone Therapy American College of Obstetricians and Gynecologists Women’s Health Care Physicians: Summary of balancing risks and benefits. Obstet Gynecol 2004, 104:128S–129S.CrossRef
- Hormone therapy and stroke: Is it all about timing?
Current Treatment Options in Cardiovascular Medicine
Volume 11, Issue 3 , pp 241-250
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- Current Science Inc.
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- Cheryl Bushnell (1)
- Author Affiliations
- 1. Women’s Health Center of Excellence for Research, Leadership, and Education, Wake Forest Health Sciences University, Medical Center Boulevard, Winston-Salem, NC, 27157, USA