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Hormone replacement therapy and ischemic stroke severity in women

A case-control study

From the Duke Center for Cerebrovascular Disease (Drs. Bushnell and Goldstein), Department of Medicine (Neurology) Duke University Medical Center; Duke Center for Clinical Health Policy and Research (Drs. Samsa and Goldstein); and Durham VA Medical Center (Dr. Goldstein), Durham, NC.

Address correspondence and reprint requests to Dr. Cheryl D. Bushnell, P.O. Box 2900, Duke University Medical Center, Durham, NC 27710; e-mail: bushn002{at}mc.duke.edu

OBJECTIVE: To investigate whether ischemic stroke severity differed among women who were receiving hormone replacement therapy (HRT) as compared with those who were not receiving these drugs.

BACKGROUND: Estrogen has a neuroprotective effect in animal models of ischemic stroke, but data reflecting the impact of HRT on ischemic stroke severity in humans are lacking.

METHODS: All women receiving HRT at the time of admission for acute ischemic stroke to an academic medical center over 3 years were identified by medical record review (n = 58). HRT users were matched with 116 HRT nonusers by age and number of stroke risk factors. Stroke severity was assessed retrospectively with the Canadian Neurological Scale. Data were analyzed with nonparametric univariate tests (Spearman rank and ² tests) and linear regression modeling using nonparametric matched-pair analysis.

RESULTS: History of congestive heart failure or coronary artery disease (p = 0.01), atrial fibrillation (p = 0.02), and African American race (p = 0.04), were significantly associated with greater stroke severity in the univariate analysis. There was a nonsignificant trend toward lesser stroke severity in HRT users (median Canadian Neurological Scale score, 10, vs 9.5 in non-HRT users, p = 0.08). Multivariate analysis showed no independent effect of HRT use on stroke severity (F = 1.24, p = 0.17).

CONCLUSIONS: There was no significant effect of HRT status on stroke severity. Because this was a retrospective analysis, prospective studies are also needed to further elucidate any potential neuroprotective effect of hormone replacement.

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