Hormone replacement therapy and ischemic stroke severity in women - A case-control study

Objective: To investigate whether ischemic stroke severity differed among w omen who were receiving hormone replacement therapy (HRT) as compared with those who were not receiving these drugs. Background: Estrogen has a neurop rotective effect in animal models of ischemic stroke, but data reflecting t he impact of HRT on ischemic stroke severity in humans are lacking. Methods : All women receiving HRT at the time of admission for acute ischemic strok e to an academic medical center over 3 years were identified by medical rec ord review (n = 58). HRT users were matched with 116 HRT nonusers by age an d number of stroke risk factors. Stroke severity was assessed respectively with the Canadian Neurological Scale. Data were analyzed with nonparametric univariate tests (Spearman rank and x(2) tests) and linear regression mode ling using nonparametric matched-pair analysis. Results: History of congest ive heart failure or coronary artery disease (p = 0.01), atrial fibrillatio n (p = 0.02), and African American race (p = 0.04), were significantly asso ciated with greater stroke severity in the univariate analysis. There was a nonsignificant trend toward lesser stroke severity in HRT users (median Ca nadian Neurological Scale score, 10, vs 9.5 in non-HRT users, p = 0.08). Mu ltivariate analysis showed no independent effect of HRT use on stroke sever ity (F = 1.24, p = 0.17). Conclusions: There was no significant effect of H RT status on stroke severity. Because this was a retrospective analysis, pr ospective studies are also needed to further elucidate any potential neurop rotective effect of hormone replacement.