Stroke: postmenopausal exogenous hormones decreased the risk of death, and may decrease stroke risk.

Clinical bottom line (level 1b)

  1. A seventh of postmenopausal women will had a stroke at 11.3 years.
  2. Patients who had taken postmenopausal hormones may be at a decreased risk of stroke but there was no clear benefit.
  3. Patients who had taken postmenopausal hormones were at a decreased risk of death if they had taken postmenopausal hormones.
Finucane et al: Archives of Internal Medicine 1993; 153: 73-79
Expires November 2002

The study

Prospective cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: population-based, USA

1910 patients (aged range 55 to 74 years, 100% female) white postmenopausal women with no reported history of stroke

Excluded if
  • lost to follow-up in the first follow-up wave
  • failed to have an interview in the first follow-up wave
  • missing information from the first follow-up interview
  • missing baseline data on cardiovascular disease risk factors




    • Multivariate analyses were used to adjust for confounding factors.

    followed for mean 11.3 years
    Outcomes studied:
  • stroke
  • mortality

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    stroke mean 11.3 years 250/1910 13.1%
    (11.6% to 14.6%)
    mortality mean 11.3 years 64/1910 3.35%
    (2.54% to 4.16%)

    prognostic factor for
    stroke     		time to outcome adjusted RR
    (95% CI)    		 NNF+
    (95% CI)
    postmenopausal hormone use mean 11.3 years 0.69
    (0.14 to 1.00)     		-4
    (-1 to -)

    prognostic factor for
    mortality     		time to outcome adjusted RR
    (95% CI)    		 NNF+
    (95% CI)
    postmenopausal hormone use mean 11.3 years 0.37
    (0.14 to 0.92)     		-2
    (-16 to -1)

    Comments

    1. Three data collection waves were performed in this study.
    2. 436 responders to follow-up were completed by proxy.
    3. Postmenopausal women were richer, better educated, younger, thinner and less hypertensive than the controls.
    4. There are a number of studies with varying estimates of effect - the (smaller) RCTs do not give strong evidence of effectiveness as a therapeutic option. (Classed as 2b)

    Citation

    1. Finucane FF, Madans JH, Bush TL, et al: Decreased risk of stroke among postmenopausal hormone users: Results from a national cohort. Archives of Internal Medicine 1993; 153: 73-79
    Search Terms: stroke in Best Evidence
    Contributor: Nick Shenker and Clare Wotton, November 1999
    Reviewer: Urs Glenck

    Clinical Question.
    Patient white postmenopausal women
    Intervention or Exposure hormone use
    Comparison no hormone use
    Outcome stroke