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Association between hormone replacement therapy and subsequent stroke: a meta-analysis.

Philip M W Bath¹, Laura J Gray

¹Division of Stroke Medicine, Institute of Neuroscience, Queen's Medical Centre, University of Nottingham, Nottingham NG7 2UH. philip.bath@nottingham.ac.uk

BMJ (Clinical Research Ed.)

|January 11, 2005

Summary

Hormone replacement therapy (HRT) significantly increases stroke risk, especially ischemic stroke. HRT use is linked to worse stroke outcomes and is not recommended for stroke prevention.

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Area of Science:

Cardiovascular Medicine
Endocrinology
Epidemiology

Background:

Hormone replacement therapy (HRT) is used to manage menopausal symptoms.
Concerns exist regarding the cardiovascular risks associated with HRT.

Purpose of the Study:

To systematically review trials on HRT's effect on stroke risk.
To analyze stroke by pathological type, severity, and patient outcomes.

Main Methods:

Systematic review of 28 randomized controlled trials involving 39,769 subjects.
Random effects model used for cerebrovascular event rate analysis.
Sensitivity analyses included prevention phase, HRT type, estrogen type, trial size, follow-up duration, sex, and quality.

Main Results:

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HRT significantly increased total stroke (OR 1.29) and non-fatal stroke (OR 1.23).
Increased risk observed for ischemic stroke (OR 1.29) and stroke leading to death/disability (OR 1.56).
No significant association found for hemorrhagic stroke or transient ischemic attack.

Conclusions:

HRT is associated with a higher risk of stroke, particularly ischemic stroke.
Patients on HRT experiencing stroke may have poorer outcomes.
HRT is not recommended for primary or secondary stroke prevention.