Association between hormone replacement therapy and subsequent stroke: a meta-analysis
Open Access
- 7 January 2005
- Vol. 330 (7487), 342
- https://doi.org/10.1136/bmj.38331.655347.8f
Abstract
Abstract Objectives To review completed trials assessing effect of hormone replacement therapy on subsequent risk of stroke, assessing stroke by pathological type, severity, and outcome. Effect of hormone replacement therapy on stroke and its type and outcome, and transient ischaemic attack Design Systematic review of randomised controlled trials identified from the Cochrane Library, Embase, and Medline; reviews; and reference lists of relevant papers. Studies reviewed 28 trials, with 39 769 subjects, were identified. Review measures Rates for cerebrovascular events analysed with a random effects model. Sensitivity analyses for heterogeneity included phase of prevention (primary or secondary), type of hormone replacement therapy (oestrogen alone or combined with progesterone), type of oestrogen (estradiol or conjugated equine oestrogen), size of trial (< 5000 or > 5000 patients), length of follow up (£ 3 years or > 3 years), sex (women only or men only), and trial quality (high or low). Results Hormone replacement therapy was associated with significant increases in total stroke (odds ratio 1.29 (95% confidence interval 1.13 to 1.47), n = 28), non-fatal stroke (1.23 (1.06 to 1.44), n = 21), stroke leading to death or disability (1.56 (1.11 to 2.20), n = 14), ischaemic stroke (1.29 (1.06 to 1.56), n = 16), and a trend to more fatal stroke (1.28 (0.87 to 1.88), n = 22). It was not associated with haemorrhagic stroke (1.07 (0.65 to 1.75), n = 17) or transient ischaemic attack (1.02 (0.78 to 1.34), n = 22). Statistical heterogeneity was not present in any analysis. Conclusions Hormone replacement therapy was associated with an increased risk of stroke, particularly of ischaemic type. Among subjects who had a stroke, those taking hormone replacement therapy seemed to have a worse outcome. Hormone replacement therapy cannot be recommended for the primary or secondary prevention of stroke.Keywords
This publication has 14 references indexed in Scilit:
- Mortality associated with hormone replacement therapy in younger and older womenJournal of General Internal Medicine, 2004
- High-risk elderly patients PROSPER from cholesterol-lowering therapyThe Lancet, 2002
- Evidence from randomised trials on the long-term effects of hormone replacement therapyThe Lancet, 2002
- Postmenopausal Hormone Replacement TherapyJAMA, 2002
- Clinical cardiovascular studies of hormone replacement therapyThe American Journal of Cardiology, 2002
- Effects of hormone replacement therapy on cognitive aging and dementia risk in postmenopausal women: a review of ongoing large-scale, long-term clinical trials.2002
- Hormone replacement therapy and stroke: risk, protection or no effect?Maturitas, 2001
- A Review of the Evidence for the Use of Phytoestrogens as a Replacement for Traditional Estrogen Replacement TherapyArchives of Internal Medicine, 2001
- Effects of progestogens on thrombosis and atherosclerosisHuman Reproduction Update, 1999
- Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses?The Lancet, 1998