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ACP Journal Club |18 October 2016

In postmenopausal women, oral but not transdermal estrogen was associated with increased risk for stroke

Susan M. Ott, MD

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Canonico M, Carcaillon L, Plu-Bureau G, et al. Postmenopausal hormone therapy and risk of stroke: impact of the route of estrogen administration and type of progestogen. Stroke. 2016;47:1734-41. 27256671

GIM/FP/GP:

Endocrinology:

Hematol/Thrombo:

In postmenopausal women, is hormone therapy (HT) linked to increased risk for stroke? Does risk differ by method of estrogen administration?
Nested case–control study using data from linked national health care databases.
France.
3144 women 51 to 62 years of age (mean age 57 y) who had a first hospitalization for ischemic stroke between Apr 2009 and Dec 2011 (index date = date of hospitalization). Exclusion criteria included ischemic stroke as a secondary diagnosis or related to cerebral infarction sequelae, stroke occurring in after care or rehabilitation units or home hospitalization, contraindication to HT (history of gynecologic cancer or cardiovascular disease), or use of antithrombotic therapy in the past 3 months. Each woman hospitalized for a first stroke (case) was matched on age (in 1-y bands) and ZIP code with ≤ 4 randomly selected controls who were healthy; had no hospitalizations between 2009 and 2011 and no contraindications to HT use; did not have International Classification of Diseases, 10th revision (ICD-10), codes for chronic cardiovascular disease or gynecologic cancer; and were not receiving antithrombotic therapy (controls n = 12 158).
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Ott SM. In postmenopausal women, oral but not transdermal estrogen was associated with increased risk for stroke. Ann Intern Med. ;165:JC46. doi: 10.7326/ACPJC-2016-165-8-046

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Published: Ann Intern Med. 2016;165(8):JC46.

DOI: 10.7326/ACPJC-2016-165-8-046

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2016 American College of Physicians
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