Cargando…
Postmenopausal Hormone Therapy and Risk of Stroke: Impact of the Route of Estrogen Administration and Type of Progestogen
BACKGROUND AND PURPOSE—: The benefit/risk analysis of hormone therapy in postmenopausal women is not straightforward and depends on cardiovascular disease. Evidence supports the safety of transdermal estrogens and the importance of progestogens for thrombotic risk. However, the differential associat...
Autores principales: | , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2016
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4927222/ https://www.ncbi.nlm.nih.gov/pubmed/27256671 http://dx.doi.org/10.1161/STROKEAHA.116.013052 |
_version_ | 1782440240725622784 |
---|---|
author | Canonico, Marianne Carcaillon, Laure Plu-Bureau, Geneviève Oger, Emmanuel Singh-Manoux, Archana Tubert-Bitter, Pascale Elbaz, Alexis Scarabin, Pierre-Yves |
author_facet | Canonico, Marianne Carcaillon, Laure Plu-Bureau, Geneviève Oger, Emmanuel Singh-Manoux, Archana Tubert-Bitter, Pascale Elbaz, Alexis Scarabin, Pierre-Yves |
author_sort | Canonico, Marianne |
collection | PubMed |
description | BACKGROUND AND PURPOSE—: The benefit/risk analysis of hormone therapy in postmenopausal women is not straightforward and depends on cardiovascular disease. Evidence supports the safety of transdermal estrogens and the importance of progestogens for thrombotic risk. However, the differential association of oral and transdermal estrogens with stroke remains poorly investigated. Furthermore, there are no data regarding the impact of progestogens. METHODS—: We set up a nested case–control study of ischemic stroke (IS) within all French women aged 51 to 62 years between 2009 and 2011 without personal history of cardiovascular disease or contraindication to hormone therapy. Participants were identified using the French National Health Insurance database, which includes complete drug claims for the past 3 years and French National hospital data. We identified 3144 hospitalized IS cases who were matched for age and zip code to 12 158 controls. Conditional logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (95% CI). RESULTS—: Compared with nonusers, the adjusted ORs of IS were1.58 (95% CI, 1.01–2.49) in oral estrogen users and 0.83 (0.56–1.24) in transdermal estrogens users (P<0.01). There was no association of IS with use of progesterone (OR, 0.78; 95% CI, 0.49–1.26), pregnanes (OR, 1.00; 95% CI, 0.60–1.67), and nortestosterones (OR, 1.26; 95% CI, 0.62–2.58), whereas norpregnanes increased IS risk (OR, 2.25; 95% CI, 1.05–4.81). CONCLUSIONS—: Both route of estrogen administration and progestogens were important determinants of IS. Our findings suggest that transdermal estrogens might be the safest option for short-term hormone therapy use. |
format | Online Article Text |
id | pubmed-4927222 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-49272222016-07-13 Postmenopausal Hormone Therapy and Risk of Stroke: Impact of the Route of Estrogen Administration and Type of Progestogen Canonico, Marianne Carcaillon, Laure Plu-Bureau, Geneviève Oger, Emmanuel Singh-Manoux, Archana Tubert-Bitter, Pascale Elbaz, Alexis Scarabin, Pierre-Yves Stroke Original Contributions BACKGROUND AND PURPOSE—: The benefit/risk analysis of hormone therapy in postmenopausal women is not straightforward and depends on cardiovascular disease. Evidence supports the safety of transdermal estrogens and the importance of progestogens for thrombotic risk. However, the differential association of oral and transdermal estrogens with stroke remains poorly investigated. Furthermore, there are no data regarding the impact of progestogens. METHODS—: We set up a nested case–control study of ischemic stroke (IS) within all French women aged 51 to 62 years between 2009 and 2011 without personal history of cardiovascular disease or contraindication to hormone therapy. Participants were identified using the French National Health Insurance database, which includes complete drug claims for the past 3 years and French National hospital data. We identified 3144 hospitalized IS cases who were matched for age and zip code to 12 158 controls. Conditional logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (95% CI). RESULTS—: Compared with nonusers, the adjusted ORs of IS were1.58 (95% CI, 1.01–2.49) in oral estrogen users and 0.83 (0.56–1.24) in transdermal estrogens users (P<0.01). There was no association of IS with use of progesterone (OR, 0.78; 95% CI, 0.49–1.26), pregnanes (OR, 1.00; 95% CI, 0.60–1.67), and nortestosterones (OR, 1.26; 95% CI, 0.62–2.58), whereas norpregnanes increased IS risk (OR, 2.25; 95% CI, 1.05–4.81). CONCLUSIONS—: Both route of estrogen administration and progestogens were important determinants of IS. Our findings suggest that transdermal estrogens might be the safest option for short-term hormone therapy use. Lippincott Williams & Wilkins 2016-07 2016-06-27 /pmc/articles/PMC4927222/ /pubmed/27256671 http://dx.doi.org/10.1161/STROKEAHA.116.013052 Text en © 2016 The Authors. Stroke is published on behalf of the American Heart Association, Inc., by Wolters Kluwer. This is an open access article under the terms of the Creative Commons Attribution Non-Commercial-NoDervis (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited, the use is noncommercial, and no modifications or adaptations are made. |
spellingShingle | Original Contributions Canonico, Marianne Carcaillon, Laure Plu-Bureau, Geneviève Oger, Emmanuel Singh-Manoux, Archana Tubert-Bitter, Pascale Elbaz, Alexis Scarabin, Pierre-Yves Postmenopausal Hormone Therapy and Risk of Stroke: Impact of the Route of Estrogen Administration and Type of Progestogen |
title | Postmenopausal Hormone Therapy and Risk of Stroke: Impact of the Route of Estrogen Administration and Type of Progestogen |
title_full | Postmenopausal Hormone Therapy and Risk of Stroke: Impact of the Route of Estrogen Administration and Type of Progestogen |
title_fullStr | Postmenopausal Hormone Therapy and Risk of Stroke: Impact of the Route of Estrogen Administration and Type of Progestogen |
title_full_unstemmed | Postmenopausal Hormone Therapy and Risk of Stroke: Impact of the Route of Estrogen Administration and Type of Progestogen |
title_short | Postmenopausal Hormone Therapy and Risk of Stroke: Impact of the Route of Estrogen Administration and Type of Progestogen |
title_sort | postmenopausal hormone therapy and risk of stroke: impact of the route of estrogen administration and type of progestogen |
topic | Original Contributions |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4927222/ https://www.ncbi.nlm.nih.gov/pubmed/27256671 http://dx.doi.org/10.1161/STROKEAHA.116.013052 |
work_keys_str_mv | AT canonicomarianne postmenopausalhormonetherapyandriskofstrokeimpactoftherouteofestrogenadministrationandtypeofprogestogen AT carcaillonlaure postmenopausalhormonetherapyandriskofstrokeimpactoftherouteofestrogenadministrationandtypeofprogestogen AT plubureaugenevieve postmenopausalhormonetherapyandriskofstrokeimpactoftherouteofestrogenadministrationandtypeofprogestogen AT ogeremmanuel postmenopausalhormonetherapyandriskofstrokeimpactoftherouteofestrogenadministrationandtypeofprogestogen AT singhmanouxarchana postmenopausalhormonetherapyandriskofstrokeimpactoftherouteofestrogenadministrationandtypeofprogestogen AT tubertbitterpascale postmenopausalhormonetherapyandriskofstrokeimpactoftherouteofestrogenadministrationandtypeofprogestogen AT elbazalexis postmenopausalhormonetherapyandriskofstrokeimpactoftherouteofestrogenadministrationandtypeofprogestogen AT scarabinpierreyves postmenopausalhormonetherapyandriskofstrokeimpactoftherouteofestrogenadministrationandtypeofprogestogen |