Hormone therapy and the risk of stroke after acute myocardial infarction in postmenopausal women.
OBJECTIVE
We examined the association of hormone therapy (HRT) with hemorrhagic and ischemic stroke among postmenopausal women with acute myocardial infarction (AMI).


BACKGROUND
Hemorrhagic and ischemic strokes are common complications of AMI, and women are at increased risk for hemorrhagic stroke after thrombolytic therapy. This risk may be related to female hormones.


METHODS
Using data from the National Registry of Myocardial Infarction-3, we studied 114,724 women age 55 years or older admitted to the hospital for AMI, of whom 7,353 reported HRT use on admission. We determined rates of in-hospital hemorrhagic and ischemic stroke stratified by HRT use and estimated the independent association of HRT with each stroke type using multivariable logistic regression.


RESULTS
The HRT users were younger than non-users, had fewer risk factors for stroke including diabetes and prior stroke, and received more pharmacologic and invasive therapy including cardiac catheterization. A total of 2,152 (1.9%) in-hospital strokes occurred, with 442 (0.4%) hemorrhagic, 1,017 (0.9%) ischemic and 693 (0.6%) unspecified. Among HRT users and non-users, the rates of hemorrhagic stroke (0.40% vs. 0.42%, p = 1.00) and ischemic stroke (0.80% vs. 0.96%, p = 0.11) were similar. Among 13,328 women who received thrombolytic therapy, the rate of hemorrhagic stroke was not significantly different for users and non-users (1.6% vs. 2.1%, p = 0.22). After adjustment for baseline and treatment differences, HRT was not associated with hemorrhagic (odds ratio [OR], 0.88; 95% confidence intervals [CI], 0.58 to 1.35) or ischemic stroke (OR, 0.89; CI, 0.66 to 1.18).


CONCLUSIONS
Acute myocardial infarction is a high-risk setting for stroke among postmenopausal women, but HRT does not appear to modify that risk. Clinicians should not alter their approach to thrombolytic therapy based on HRT use.
Angeja
B G
BG
Department of Medicine, University of California, San Francisco, California 94143, USA. bangeja@medicine.ucsf.edu
Shlipak
M G
MG
Go
A S
AS
Johnston
S C
SC
Frederick
P D
PD
Canto
J G
JG
Barron
H V
HV
Grady
D
D
D017677:Age Distribution; D000368:Aged; D002545:Brain Ischemia / Q000453:epidemiology / Q000209:etiology*; D002543:Cerebral Hemorrhage / Q000453:epidemiology / Q000209:etiology*; D015914:Estrogen Replacement Therapy / Q000009:adverse effects*; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications* / Q000188:drug therapy*; D018579:Patient Selection; D017698:Postmenopause / Q000187:drug effects*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D020521:Stroke / Q000139:chemically induced* / Q000453:epidemiology / Q000209:etiology*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
D005343:Fibrinolytic Agents