Stroke Risk Increased in Hypertensive Women Using HRT
Wednesday, October 22nd 2003
In a Danish study, hypertensive women who used hormone replacement therapy (HRT) were more than twice as likely as nonusers to experience a stroke, new research shows. In contrast, HRT use did not raise the stroke risk among normotensive women.
The current findings are in agreement with those from the Women's Health Initiative trial, first reported last year. However, whereas women in the WHI trial received estrogen and medroxyprogesterone, those in the present study primarily received estradiol combined with norethisterone.
The new findings, which are published in the October issue of the Archives of Neurology, are based on an analysis of data from 13,122 postmenopausal women who participated in the Danish Nurse Study. When surveyed in 1993, most of the women reported never using HRT, 28% were current users, and 14.3% were past users.
Between enrollment in 1993 and follow-up in 1998, 144 women experienced an ischemic or hemorrhagic stroke, lead author Dr. Ellen Lokkegaard, from the National Institute of Public Health in Copenhagen, and colleagues note.
In the overall analysis, HRT use was not consistently linked to stroke. When the analysis was limited to hypertensive subjects, however, a significant association emerged.
Among hypertensive women, current HRT use increased the stroke risk by 2.35-fold compared with never use. Current estrogen use alone raised the risk by 1.54-fold, whereas use of combination therapy increased the risk by threefold, the researchers found.
Although further confirmation is needed, the results suggest that HRT use should be avoided in women with hypertension, the investigators note.
This recommendation seems reasonable, Dr. Douglas A. Dulli, from the University of Wisconsin Medical School in Madison, notes in a related editorial. "But given current data from the authors and elsewhere, I would also withhold HRT in menopausal patients with diabetes and in those with any risk factors for atherosclerotic vascular disease, thromboembolism, or breast cancer."
Further studies should focus on identifying a group, if any, in which HRT is acceptably safe, Dr. Dulli adds. "Until such data are presented, the safe default therapy for most postmenopausal patients seems to HRTless."
Sourced from Archives of Neurology 2003;60:1363-1364,1379-1384.
Footnote from Ideal Health:
The following supplements are all useful for HRT alternatives:
Related health information can be found here:
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