Hormone therapy and the risk of stroke after acute myocardial infarction in postmenopausal women

Objectives We examined the association of hormone therapy (HRT) with hemorr hagic and ischemic stroke among postmenopausal women with acute myocardial infarction (AMI). Background Hemorrhagic and ischemic strokes are common complications of AML and women are at increased risk for hemorrhagic stroke after thrombolytic therapy. This risk may be related to female hormones. Methods Using data from the National Registry of Myocardial Infarction-3, w e studied 114,724 women age 55 years or older admitted to the hospital for AMI, of whom 7,353 reported HRT use on admission. We determined rates of in -hospital hemorrhagic and ischemic stroke stratified by HRT use and estimat ed the independent association of HRT with each stroke type using multivari able logistic regression. Results The HRT users were younger than non-users, had fewer risk factors f or stroke including diabetes and prior stroke, and received more pharmacolo gic and invasive therapy including cardiac catheterization. A total of 2,15 2 (1.9%) in-hospital strokes occurred, with 442 (0.4%) hemorrhagic, 1,017 ( 0.9%) ischemic and 693 (0.6%) unspecified. Among HRT users and non-users, t he rates of hemorrhagic stroke (0.40% vs. 0.42%, p=1.00) and ischemic strok e (0.80% vs. 0.96%, p=0.11) were similar. Among 13,328 women who received t hrombolytic therapy, the rate of hemorrhagic stroke was not significantly d ifferent for users and non-users (1.6% vs. 2.1%, p=0.22). After adjustment for baseline, and treatment differences, HRT was not associated with hemorr hagic (odds ratio [OR], 0.88; 95% confidence intervals [CI], 0.58 to 1.35) or ischemic stroke (OR, 0.89; CI, 0.66 to 1.18). Conclusions Acute myocardial infarction is a high-risk setting for stroke a mong postmenopausal women, but HRT does not appear to modify that risk. Cli nicians should not alter their approach; to thrombolytic therapy based on H RT use. (J Am Coll Cardiol 2001;38:1297-301) (C) 2001 by the American Colle ge of Cardiology.