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Risk of stroke in healthy postmenopausal women during and after hormone therapy: a meta-analysis

Gu, Haifeng MD, MS1; Zhao, Xiaohong MD, MS1; Zhao, Xiaoping MD, MS2; Yang, Yunmei MD, PhD1; Lv, Xueying MD1

Menopause:
doi: 10.1097/GME.0000000000000227
Original Articles
Abstract

Objective: This meta-analysis aims to examine the risk of stroke in healthy postmenopausal women during and after hormone therapy (HT).

Methods: Medline, The Cochrane Library, EMBASE, and Google Scholar were searched for randomized controlled trials involving healthy postmenopausal women who received HT and were followed up for at least 3 years after starting treatment. The primary outcome measures were stroke hazard ratio (HR) for the intervention phase, stroke HR for the postintervention phase, and overall stroke HR.

Results: Four studies, involving 15,423 participants who received HT and 14,582 participants who received placebo, met the criteria for inclusion in the meta-analysis. The mean age of participants ranged from approximately 50 to 64 years. HT was given as conjugated equine estrogens in three studies and as 17β-estradiol in one study. The duration of HT ranged from 3.0 to 10.1 years. The length of follow-up after the start of HT ranged from 3.0 to 15.8 years. Meta-analysis revealed that the stroke HR during the intervention phase and the overall stroke HR were significantly increased among women who received HT (intervention phase: pooled HR, 1.32; 95% CI, 1.12-1.56; P = 0.001; overall: pooled HR, 1.15; 95% CI, 1.03-1.28; P = 0.017). The stroke HR during the postintervention phase was not increased among women who received HT (pooled HR, 1.00; 95% CI, 0.85-1.16; P = 0.958). Sensitivity analysis confirmed the reliability of the meta-analysis for both outcomes.

Conclusions: These findings suggest that HT may increase the risk of stroke during, but not after, HT in healthy postmenopausal women.

Author Information

From 1The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; and 2Nursing Department, Zhejiang Medical College, Hangzhou, China.

Received October 17, 2013; revised and accepted January 30, 2014.

Funding/support: This work is supported by the Foundation for General Project in the Health Department of Zhejiang province (Grant No. 2012KYB08).

Financial disclosure/conflicts of interest: None reported.

Address correspondence to: Xueying Lv, MD, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China. E-mail: lvxueying1@sina.com

© 2014 by The North American Menopause Society.