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Results From a National Cohort

Fanchon F. Finucane, MHS; Jennifer H. Madans, PhD; Trudy L. Bush, PhD; Pamela H. Wolf, DrPH; Joel C. Kleinman, PhD

Arch Intern Med. 1993;153(1):73-79.

Abstract
Objective
To assess the impact of postmenopausal hormone use on the risk of stroke incidence and stroke mortality.

Design
Longitudinal study consisting of three data collection waves. The average follow up for cohort members was 11.9 years (maximum, 16.3 years). Cox proportional hazards regression models were used to estimate the relative risk of stroke for postmenopausal hormone ever-users compared with never-users.

Participants
A national sample of 1910 (of 2371 eligible) white postmenopausal women who were 55 to 74 years old when examined in 1971 through 1975 as part of the first National Health and Nutrition Examination Survey and who did not report a history of stroke at that time.

Main Outcome Measure
The main outcome measure was incident stroke (fatal and nonfatal). Events were determined from discharge diagnosis information coded from hospital and nursing home records and cause of death information coded from death certificates collected during the follow-up period (1971 through 1987).

Results
There were 250 incident cases of stroke identified, including 64 deaths with stroke listed as the underlying cause. The age-adjusted incidence rate of stroke among postmenopausal hormone ever-users was 82 per 10 000 woman-years of follow-up compared with 124 per 10 000 among never-users. Postmenopausal hormone use remained a protective factor against stroke incidence (relative risk, 0.69; 95% confidence interval, 0.47 to 1.00) and stroke mortality (relative risk, 0.37; 95% confidence interval, 0.14 to 0.92) after adjusting for the baseline risk factors of age, systolic blood pressure, diabetes, body mass index, smoking, history of hypertension and heart attack, and socioeconomic status.

Conclusions
The results suggest that postmenopausal hormone use is associated with a decrease in risk of stroke incidence and mortality in white postmenopausal women.

(Arch Intern Med. 1993;153:73-79)

Author Affiliations
From the Office of Analysis and Epidemiology, National Center for Health Statistics, Hyattsville, Md (Ms Finucane and Drs Madans and Kleinman); Department of Epidemiology, Johns Hopkins University, School of Hygiene and Public Health, Baltimore, Md (Dr Bush); and Office of Population, Agency for International Development, Washington, DC (Dr Wolf).

Footnotes
Ms Finucane is now with the Colorado Department of Health, Denver.

Deceased.

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