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October 2003

Stroke Risk, Hypertension, and HRTless Postmenopausal Therapy

Arch Neurol. 2003;60(10):1363-1364. doi:10.1001/archneur.60.10.1363

RESULTS OF A STUDY by Løkkegaard et al1 in this month's ARCHIVES suggest that particular caution be given to the prescription of hormone therapy (HRT) to hypertensive postmenopausal women, at least in terms of increased risk for stroke. This study addressed stroke risk during a 5-year period in 13 122 healthy postmenopausal women who participated in the Danish Nurse Cohort Study.2 Participants were studied by means of an initial questionnaire, and outcomes, by means of periodic sampling of the National Patient Registry of Hospital Discharges, which registers all hospital admissions in Denmark. The salient finding of the Løkkegaard study is that although no risk for total stroke was found with HRT use, there was significant 5-year hazard with the use of combined HRT in hypertensive women for ischemic stroke (hazard ratio, 5.01; 95% CI, 2.09-12.00). The study also noted lesser hazard for uncombined estradiol use in ischemic stroke and for combined HRT for total stroke. In a similar study model with this same cohort, these authors found no protective benefit from HRT for ischemic heart disease, and increased hazard for ischemic heart disease and death from all causes in diabetic HRT users.3

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