Transdermal and oral hormone replacement therapy and the risk of stroke: a nested case-control study

作者：Christel Renoux, Sophie Dell’Aniello, Edeltraut Garbe, Samy Suissa · 发表于：BMJ · 年份：2010 · DOI：10.1136/bmj.c2519 · 被引用次数：384 · 研究领域：Menopause: Health Impacts and Treatments、Hormonal and reproductive studies、Nausea and vomiting management

OBJECTIVES: To determine the risk of stroke associated with oral and transdermal routes of administration of hormone replacement therapy. DESIGN: Population based nested case-control study. Setting About 400 general practices in the United Kingdom contributing to the General Practice Research Database. Participants Cohort of all women in the database aged 50-79 years between 1 January 1987 and 31 October 2006 who were members of a practice that fulfilled predefined quality criteria and without a diagnosis of stroke before cohort entry. For each case of stroke occurring during follow-up, up to four controls were selected from among the cohort members in the risk sets defined by the case. Exposure to hormone replacement therapy (HRT) was categorised into oestrogens only, oestrogens plus progestogen, progestogen only, and tibolone. Oestrogens were further subdivided according to the route of administration (oral v transdermal) and dose (high v low). Main outcome measures Rate ratio of stroke associated with current use of oral and transdermal HRT compared with no use. Current use was considered as a prescription whose duration included the index date. RESULTS: There were 15,710 cases of stroke matched to 59 958 controls. The rate of stroke in the cohort was 2.85 per 1000 per year. The adjusted rate ratio of stroke associated with current use of transdermal HRT was 0.95 (95% CI 0.75 to 1.20) relative to no use. The risk of stroke was not increased with use of low oestrogen dose p...