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(Arteriosclerosis, Thrombosis, and Vascular Biology. 2002;22:1051-a.)
© 2002 American Heart Association, Inc.

Letters to the Editor

Hormone Replacement Therapy, Prothrombotic Mutations, and the Risk of Incident Nonfatal Ischemic Stroke in Postmenopausal Women

Rozenn N. Lemaitre; Bruce M. Psaty; Susan R Heckbert; Nicholas L Smith

Departments of Medicine (RNL, BMP) and Epidemiology (BMP, SRH, NLS), Cardiovascular Health Research Unit, Seattle, Wash

W.T. Longstreth, Jr

Department of Neurology, University of Washington, Seattle, Wash

Frits R. Rosendaal

Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands

To the Editor:

In secondary-prevention clinical trials, hormone replacement therapy (HRT) has not decreased the risk of coronary events¹ or the risk of stroke² in postmenopausal women. In fact, post hoc analyses in both trials suggested early harm from HRT use.^1,3 We recently reported that HRT use was associated with the risk of first nonfatal myocardial infarction in hypertensive postmenopausal women with the prothrombin 20210GA variant but not in women without the variant.⁴ We now report the possibility of a similar interaction on the risk of first nonfatal ischemic stroke in the same study population.

We conducted a population-based case-control study at Group Health Cooperative (GHC), a Seattle-based health maintenance organization. Cases were 130 postmenopausal women, 30 to 79 years old, with a first nonfatal ischemic stroke between 1995 and 1998. Controls were a random sample of 692 postmenopausal women without stroke, frequency matched to cases by age, calendar year, and hypertension. We identified study subjects from GHC databases and reviewed the medical record to establish their eligibility. We used the GHC pharmacy database to assess HRT use. A woman was classified as a current user if she received enough pills to last until the date of admission for stroke cases or until a random date within their calendar year for controls. Presence of factor V Leiden (factor V 1691GA) and the prothrombin 20210GA variant in subjects’ blood specimens was assessed as previously described.⁴

Prevalence of factor V Leiden and prothrombin variant among controls was 5.5% and 2.3%, respectively. Considered . . . [Full Text of this Article]