The risk of fatal stroke in Finnish postmenopausal hormone therapy users before and after the Women's Health Initiative: A cohort study.
OBJECTIVE
The Women's Health Initiative (WHI) study clarified the indications and contraindications for postmenopausal hormone therapy (HT). We studied the impact of the WHI results on the risk of fatal stroke in HT users in Finland.


METHODS
Retrospective analysis setting: Nationwide registers on postmenopausal HT use and causes of death between 1995 and 2009.


METHODS
Women ≥40 years (n=290,272) using systemic estradiol-based postmenopausal HT.


METHODS
Follow-up started from the first HT purchase during the pre-WHI era (1995-2001) and post-WHI era (2002-2009).


METHODS
Stroke deaths in HT users were compared with that in the age-matched background population and expressed as standardized mortality ratio (SMR) with 95% confidence intervals.


RESULTS
Overall, 311 HT users died due to stroke. The exposure to HT ≤1 year was associated with a similarly reduced 22% (0.67-0.91) risk of stroke death in the pre-WHI era and in the post-WHI era 27% (0.55-0.94). The risk reductions for HT exposure of 1-8 years in the pre-WHI era (47%, 0.42-0.65) did not differ from that in the post-WHI era (32%, 0.48-0.94). The discontinuation of HT was accompanied by a significant 33% (1.02-1.72) increase in stroke death risk in the pre-WHI era and a non-significant 32% (0.84-1.99) increase in the post-WHI era within the first post-treatment year, but no longer after 1-8 years.


CONCLUSIONS
The change in prescribing policy after the WHI study did not affect the risk of fatal stroke in Finnish HT users.
Department of Obstetrics and Gynecology, Helsinki University Hospital, PO Box 140, , 00029 HUS Helsinki, Finland.
Pauliina
P
Tuomikoski
Department of Obstetrics and Gynecology, Helsinki University Hospital, PO Box 140, , 00029 HUS Helsinki, Finland.
Heli
H
Lyytinen
EPID Research Oy, Metsänneidonkuja 12, 02130 Espoo, Finland.
Pasi
P
Korhonen
EPID Research Oy, Metsänneidonkuja 12, 02130 Espoo, Finland.
Fabian
F
Hoti
EPID Research Oy, Metsänneidonkuja 12, 02130 Espoo, Finland.
Pia
P
Vattulainen
National Institute for Health and Welfare, PO Box 30, 00271 Helsinki, Finland; Nordic School of Public Health, Gothenburg, Sweden.
Mika
M
Gissler
Department of Obstetrics and Gynecology, Helsinki University Hospital, PO Box 140, , 00029 HUS Helsinki, Finland.
Olavi
O
Ylikorkala
Department of Obstetrics and Gynecology, Helsinki University Hospital, PO Box 140, , 00029 HUS Helsinki, Finland; Folkhälsan Research Center, Helsinki, Finland. Electronic address: tomi.mikkola@hus.fi.
Tomi S
TS
Mikkola
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015914:Estrogen Replacement Therapy; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D008875:Middle Aged; D017698:Postmenopause; D065840:Protective Factors; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000401:mortality*
Cardiovascular disease; Estradiol; Menopause; Mortality