title: Raloxifene and risk for stroke based on the framingham stroke risk score.
abstract: OBJECTIVE
  Raloxifene reduces vertebral fracture and invasive breast cancer risks, but increases fatal strokes in postmenopausal women at increased coronary risk. We assessed whether this risk is concentrated in postmenopausal women already at high stroke risk.
  
  
  METHODS
  Raloxifene Use for The Heart (RUTH) enrolled 10,101 postmenopausal women (mean age 67 years) with or at increased coronary heart disease risk; Multiple Outcomes of Raloxifene Evaluation (MORE) enrolled 7705 osteoporotic postmenopausal women (mean age 66 years). A Framingham Stroke Risk Score (FSRS) was calculated for all women with no prior cerebrovascular events (n = 16,858). The validity of the FSRS was assessed in the placebo groups, and then raloxifene-associated stroke risk was analyzed by FSRS subgroups.
  
  
  RESULTS
  FSRS predicted an increased stroke risk in the placebo group of both clinical trials. There was no difference in the incidence of nonfatal strokes between the raloxifene and placebo groups in MORE or RUTH, regardless of baseline Framingham stroke risk. In RUTH, women with FSRS <13 showed no increase in raloxifene-associated fatal stroke risk (hazard ratio [HR] 1.08; 95% confidence interval [CI], 0.49-2.37). Those with FSRS >or=13 had a 75% increased risk of raloxifene-associated fatal stroke (HR 1.75; 95% CI, 1.01-3.02; interaction P = .33). In MORE, where 80% of women had a FSRS <13, no increase in fatal (HR 0.57; 95% CI, 0.19-1.68) stroke risk was observed.
  
  
  CONCLUSIONS
  Risk of fatal stroke associated with raloxifene was greater in women at high stroke risk. These results might be useful for identifying postmenopausal women at high risk of first stroke who should avoid raloxifene therapy.
authors.affiliation: Division of Epidemiology, Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, Calif 92093-0607, USA. ebarrettconnor@ucsd.edu
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Barrett-Connor
authors.forename: David A
authors.initials: DA
authors.lastname: Cox
authors.forename: Jingli
authors.initials: J
authors.lastname: Song
authors.forename: Bruce
authors.initials: B
authors.lastname: Mitlak
authors.forename: Lori
authors.initials: L
authors.lastname: Mosca
authors.forename: Deborah
authors.initials: D
authors.lastname: Grady
mesh_terms: D000368:Aged; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000517:prevention & control; D005260:Female; D006801:Humans; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy; D020849:Raloxifene Hydrochloride / Q000009:adverse effects* / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D016103:Spinal Fractures / Q000517:prevention & control; D020521:Stroke / Q000139:chemically induced*
chemical_list: D050071:Bone Density Conservation Agents; D020849:Raloxifene Hydrochloride