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CLINICAL STUDY

Hormone therapy and the risk of stroke after acute myocardial infarction in postmenopausal women¹

Brad G. Angeja, MD^*,*, Michael G. Shlipak, MD, MPH^* , Alan S. Go, MD^{* ||}, S. Claiborne Johnston, MD, PhD^*, Paul D. Frederick, MBA, MPH^¶, John G. Canto, MD, MSPH, FACC^**, Hal V. Barron, MD, FACC^{* #}, Deborah Grady, MD, MPH^* for the National Registry of Myocardial Infarction 3 Investigators

^* Department of Medicine, University of California, San Francisco, California, USA
Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
General Internal Medicine Section, VA Medical Center, San Francisco, California, USA
^|| Kaiser Permanente of Northern California Division of Research, Oakland, California, USA
^¶ Ovation Research Group, Chicago, Illinois, USA
^** University of Alabama Medical Center, Birmingham, Alabama, USA
^# Genentech, Inc., South San Francisco, California, USA

Manuscript received May 10, 2001; accepted July 23, 2001.

^* Reprint requests and correspondence: Dr. Brad G. Angeja, Fellow, Division of Cardiology, University of California, San Francisco, Box 0124, Moffitt M1182, 505 Parnassus Ave., San Francisco, California 94143 USA
bangeja{at}medicine.ucsf.edu

OBJECTIVES

We examined the association of hormone therapy (HRT) with hemorrhagic and ischemic stroke among postmenopausal women with acute myocardial infarction (AMI).

BACKGROUND

Hemorrhagic and ischemic strokes are common complications of AMI, and women are at increased risk for hemorrhagic stroke after thrombolytic therapy. This risk may be related to female hormones.

METHODS

Using data from the National Registry of Myocardial Infarction-3, we studied 114,724 women age 55 years or older admitted to the hospital for AMI, of whom 7,353 reported HRT use on admission. We determined rates of in-hospital hemorrhagic and ischemic stroke stratified by HRT use and estimated the independent association of HRT with each stroke type using multivariable logistic regression.

RESULTS

The HRT users were younger than non-users, had fewer risk factors for stroke including diabetes and prior stroke, and received more pharmacologic and invasive therapy including cardiac catheterization. A total of 2,152 (1.9%) in-hospital strokes occurred, with 442 (0.4%) hemorrhagic, 1,017 (0.9%) ischemic and 693 (0.6%) unspecified. Among HRT users and non-users, the rates of hemorrhagic stroke (0.40% vs. 0.42%, p = 1.00) and ischemic stroke (0.80% vs. 0.96%, p = 0.11) were similar. Among 13,328 women who received thrombolytic therapy, the rate of hemorrhagic stroke was not significantly different for users and non-users (1.6% vs. 2.1%, p = 0.22). After adjustment for baseline and treatment differences, HRT was not associated with hemorrhagic (odds ratio [OR], 0.88; 95% confidence intervals [CI], 0.58 to 1.35) or ischemic stroke (OR, 0.89; CI, 0.66 to 1.18).

CONCLUSIONS

Acute myocardial infarction is a high-risk setting for stroke among postmenopausal women, but HRT does not appear to modify that risk. Clinicians should not alter their approach to thrombolytic therapy based on HRT use.

Abbreviations and Acronyms   AMI = acute myocardial infarction   BP = blood pressure   CABG = coronary artery bypass graft surgery   CHF = congestive heart failure   CI = confidence intervals   HERS = Heart and Estrogen/progestin Replacement Study   HRT = hormone therapy   NRMI-3 = National Registry of Myocardial Infarction   OR = odds ratio   PTCA = percutaneous transluminal coronary angioplasty   WEST = Women’s Estrogen for Stroke Trial

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