Department of Obstetrics & Gynecology, Columbia University, New York, New York 10032, USA.
Climacteric. 2009;12 Suppl 1:81-5. doi: 10.1080/13697130902835376.
Stroke affects one in five women and is the third leading cause of death in the United States. The incidence increases with age, and the number of females experiencing a stroke is similar to the number of men, unlike in coronary disease, where the number of females suffering from the disease is lower before menopause and then slowly becomes equal to the number of men. There are multiple risk factors for stroke, but the most significant ones influencing the relationship between hormones and stroke are obesity, hypertension and smoking. There have been multiple studies looking at the relationship between hormones and stroke. Among observational studies, 21 have shown no effect, while six have shown a decreased risk and four studies, an increased risk. It is clear that the risk of stroke with hormones is only for ischemic and not hemorrhagic stroke. Among randomized trials, the Women's Health Initiative data, because of the study's size, have provided the greatest weight in meta-analytic reviews. Overall, an increase of 20-40% has been found, and, because of various confounding factors, it has been difficult to determine whether this is statistically significant, although several studies have confirmed this for all postmenopausal women treated. However, in younger women, aged 50-59 years, there is little evidence that the risk is significantly increased, and the overall background prevalence is low: 6-8/10 000 women/year. Recent studies have suggested the risk is not increased significantly with transdermal therapy and with lower doses, although use of progestogen does not appear to influence the risk assessment. There is lack of consistent data on whether early age of initiation of therapy affects the risk. Because this risk may pertain to younger postmenopausal women, and there is a very small risk of stroke reported for young women taking oral contraceptives, it is suggested that the small risk in younger women is through an inflammatory/thrombosis mechanism in susceptible women, rather than one of atherosclerosis, as with coronary disease. Nevertheless, in younger postmenopausal women, with a lower baseline prevalence rate, even if there is a 40% increased risk, the attributable risk would result in 1-2 additional cases/10 000 women/year, which would be considered a very rare event.
中风影响五分之一的女性，是美国的第三大致死原因。发病率随年龄增长而增加，经历中风的女性数量与男性相似，与冠心病不同，在绝经前，女性患冠心病的人数较少，然后慢慢与男性人数持平。中风有多种风险因素，但对激素与中风关系影响最大的是肥胖、高血压和吸烟。有多项研究探讨了激素与中风的关系。在观察性研究中，有 21 项研究表明没有影响，有 6 项研究表明风险降低，有 4 项研究表明风险增加。显然，激素与中风的风险仅与缺血性中风有关，而与出血性中风无关。在随机试验中，由于研究规模较大，妇女健康倡议数据在荟萃分析综述中提供了最大的权重。总的来说，发现风险增加了 20-40%，由于存在各种混杂因素，很难确定这是否具有统计学意义，尽管有几项研究证实了所有接受治疗的绝经后妇女都存在这种情况。然而，在年龄较小的女性（50-59 岁）中，几乎没有证据表明风险显著增加，而且总体背景患病率较低：6-8/10000 名女性/年。最近的研究表明，经皮治疗和使用较低剂量不会显著增加风险，尽管使用孕激素似乎不会影响风险评估。关于治疗开始年龄是否会影响风险，目前还缺乏一致的数据。由于这种风险可能与较年轻的绝经后女性有关，并且有报道称服用口服避孕药的年轻女性中风风险非常低，因此建议，在易受影响的女性中，这种较小的风险是通过炎症/血栓形成机制引起的，而不是与冠心病一样的动脉粥样硬化机制。尽管如此，在年龄较小的绝经后女性中，由于基础患病率较低，即使风险增加 40%，归因风险也会导致每年每 10000 名女性增加 1-2 例，这被认为是非常罕见的事件。
