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Am Fam Physician. 2002;65(7):1430

The use of hormone replacement therapy (HRT) to reduce the risk for stroke is controversial. Previous observational studies of HRT in postmenopausal women have found conflicting results with regard to its association with stroke. Current studies have suggested that the estrogen used for contraception increases the risk for stroke while longitudinal studies have been inconclusive on the impact of HRT use on stroke rates in postmenopausal women. There is an increased risk for hemorrhagic and ischemic strokes during and after acute myocardial infarction (AMI), especially in patients receiving thrombolytic therapy. Women are also at a higher risk for hemorrhagic stroke after thrombolytic therapy than men. Angeja and colleagues studied the impact of HRT use at the time of hospital admittance for AMI on the risk for hemorrhagic and ischemic strokes.

The project was a nationwide, prospective cohort study of patients with documented AMI. The data collected were clinical characteristics, treatment patterns, and outcomes of patients presenting with AMI. Because the study did not collect information on menopausal status, the analysis was limited to women 55 years or older admitted with documented AMI.

At the time of hospital admittance, 7,353 women were receiving HRT. HRT users received more pharmacologic and invasive interventions after hospital admittance than nonusers. The overall stroke incidence was marginally lower in HRT users. After adjusting for baseline and treatment differences received in the hospital, the rates for hemorrhagic and ischemic strokes were the same in HRT users and nonusers. In addition, those using HRT who received thrombolytic therapy did not have an increased risk for hemorrhagic stroke compared to nonusers.

The authors concluded that HRT does not increase the risk for hemorrhagic or ischemic stroke or stroke case fatality in patients with AMI. They also stated that thrombolytic therapy decisions should not be based on HRT use.

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