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Journal of Epidemiology and Community Health logoLink to Journal of Epidemiology and Community Health
. 1989 Jun;43(2):173–178. doi: 10.1136/jech.43.2.173

The use of hormonal replacement therapy and the risk of stroke and myocardial infarction in women.

S G Thompson 1, T W Meade 1, G Greenberg 1
PMCID: PMC1052821  PMID: 2592907

Abstract

STUDY OBJECTIVE: To determine whether there is an association between the use of hormonal replacement therapy (HRT) and the risk of stroke and myocardial infarction (MI). DESIGN: A case-control study of women with stroke or MI was undertaken. SETTING: The cases were notified from 83 general practices to the coordinating centre at Northwick Park Hospital, where the diagnoses were independently confirmed. SUBJECTS: The cases, 603 white women aged 45-69, were each matched to two controls for age and general practitioner. Of the controls, 79% were the first eligible, 15% the second eligible and 6% were obtained at the third or more attempt. MEASUREMENTS AND MAIN RESULTS: A research nurse completed a questionnaire for each case and both controls, which included information obtained from the medical notes on the prescriptions of HRT. An independent quality control check on the selection of controls and on the abstraction of information from the medical notes was made. More than one HRT prescription had been given to 109 cases (18%) and 174 controls (14%), showing a weak association between the risk of stroke and MI and the past use of HRT (relative risk [RR] 1.36, 95% confidence interval [CI] 1.01-1.81). There was a stronger association with preparations contained progestogen alone (RR 1.90, 95% CI 1.11-3.25). On average, HRT had been used 9 years before recruitment to the study and for 15 months. However, the observed gradients of risk according to the duration of HRT use and time since HRT use do not support a causal interpretation. Also, the estimated relative risks were reduced when allowance was made for other cardiovascular risk factors. CONCLUSIONS: There is no evidence that the use of HRT as recently prescribed in the UK constitutes a major cardiovascular risk or benefit.

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Selected References

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  1. Aho K., Harmsen P., Hatano S., Marquardsen J., Smirnov V. E., Strasser T. Cerebrovascular disease in the community: results of a WHO collaborative study. Bull World Health Organ. 1980;58(1):113–130. [PMC free article] [PubMed] [Google Scholar]
  2. Bailar J. C., 3rd When research results are in conflict. N Engl J Med. 1985 Oct 24;313(17):1080–1081. doi: 10.1056/NEJM198510243131709. [DOI] [PubMed] [Google Scholar]
  3. Blackard C. E., Doe R. P., Mellinger G. T., Byar D. P. Incidence of cardiovascular disease and death in patients receiving diethylstilbestrol for carcinoma of the prostate. Cancer. 1970 Aug;26(2):249–256. doi: 10.1002/1097-0142(197008)26:2<249::aid-cncr2820260202>3.0.co;2-7. [DOI] [PubMed] [Google Scholar]
  4. Bush T. L., Barrett-Connor E., Cowan L. D., Criqui M. H., Wallace R. B., Suchindran C. M., Tyroler H. A., Rifkind B. M. Cardiovascular mortality and noncontraceptive use of estrogen in women: results from the Lipid Research Clinics Program Follow-up Study. Circulation. 1987 Jun;75(6):1102–1109. doi: 10.1161/01.cir.75.6.1102. [DOI] [PubMed] [Google Scholar]
  5. Bush T. L., Barrett-Connor E. Noncontraceptive estrogen use and cardiovascular disease. Epidemiol Rev. 1985;7:89–104. [PubMed] [Google Scholar]
  6. Colditz G. A., Willett W. C., Stampfer M. J., Rosner B., Speizer F. E., Hennekens C. H. Menopause and the risk of coronary heart disease in women. N Engl J Med. 1987 Apr 30;316(18):1105–1110. doi: 10.1056/NEJM198704303161801. [DOI] [PubMed] [Google Scholar]
  7. Gordon T., Kannel W. B., Hjortland M. C., McNamara P. M. Menopause and coronary heart disease. The Framingham Study. Ann Intern Med. 1978 Aug;89(2):157–161. doi: 10.7326/0003-4819-89-2-157. [DOI] [PubMed] [Google Scholar]
  8. Greenberg G., Thompson S. G., Meade T. W. Relation between cigarette smoking and use of hormonal replacement therapy for menopausal symptoms. J Epidemiol Community Health. 1987 Mar;41(1):26–29. doi: 10.1136/jech.41.1.26. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Henriksson P., Edhag O. Orchidectomy versus oestrogen for prostatic cancer: cardiovascular effects. Br Med J (Clin Res Ed) 1986 Aug 16;293(6544):413–415. doi: 10.1136/bmj.293.6544.413. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Jick H., Dinan B., Herman R., Rothman K. J. Myocardial infarction and other vascular diseases in young women. Role of estrogens and other factors. JAMA. 1978 Dec 1;240(23):2548–2552. [PubMed] [Google Scholar]
  11. Jick H., Dinan B., Rothman K. J. Noncontraceptive estrogens and nonfatal myocardial infarction. JAMA. 1978 Apr 3;239(14):1407–1409. [PubMed] [Google Scholar]
  12. Kay C. R. James Mackenzie Lecture 1979. The happiness pill? J R Coll Gen Pract. 1980 Jan;30(210):8–19. [PMC free article] [PubMed] [Google Scholar]
  13. Meade T. W., Greenberg G., Thompson S. G. Progestogens and cardiovascular reactions associated with oral contraceptives and a comparison of the safety of 50- and 30-microgram oestrogen preparations. Br Med J. 1980 May 10;280(6224):1157–1161. doi: 10.1136/bmj.280.6224.1157. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. ROBINSON R. W., HIGANO N., COHEN W. D. Increased incidence of coronary heart disease in women castrated prior to the menopause. Arch Intern Med. 1959 Dec;104:908–913. doi: 10.1001/archinte.1959.00270120064010. [DOI] [PubMed] [Google Scholar]
  15. Stampfer M. J., Willett W. C., Colditz G. A., Rosner B., Speizer F. E., Hennekens C. H. A prospective study of postmenopausal estrogen therapy and coronary heart disease. N Engl J Med. 1985 Oct 24;313(17):1044–1049. doi: 10.1056/NEJM198510243131703. [DOI] [PubMed] [Google Scholar]
  16. Wilson P. W., Garrison R. J., Castelli W. P. Postmenopausal estrogen use, cigarette smoking, and cardiovascular morbidity in women over 50. The Framingham Study. N Engl J Med. 1985 Oct 24;313(17):1038–1043. doi: 10.1056/NEJM198510243131702. [DOI] [PubMed] [Google Scholar]

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