Division of Health Analytics, Department of Computational and Quantitative Medicine, Beckman Research Institute and the City of Hope, Duarte, California, USA,
Division of Health Analytics, Department of Computational and Quantitative Medicine, Beckman Research Institute and the City of Hope, Duarte, California, USA.
Neuroepidemiology. 2020;54(4):320-325. doi: 10.1159/000505970. Epub 2020 Feb 11.
Postmenopausal hormone therapy (HT) increases the risk of stroke. Here we evaluate whether leisure time physical activity (LTPA) can change stroke risk in women using HT, leveraging data from the California Teachers Study.
Female California educators without a prior history of stroke (n = 118,294) were followed from 1995 through 2015 for stroke end points. Based on statewide hospitalization data, 4,437 women had ischemic (n = 3,162; International Classification of Diseases [ICD]-9 433, 434, 436) or hemorrhagic (n = 1,275; ICD-9 430-432, excluding 432.1) stroke. LTPA and HT use were evaluated at 2 time points (baseline [1995-1996] and 10-year follow-up [2005-2006]). LTPA was assessed using American Heart Association (AHA) recommendations (>150 min/week moderate or >75 min/week strenuous physical activity). Using multivariable Cox proportional hazards models, we estimated the hazard ratios (HRs) and 95% CIs for the associations between HT use and concurrent LTPA with incident stroke.
Compared to women who never used HT, stroke risk was highest among women who were current HT users and did not meet AHA recommendations for LTPA at the time of their HT use: HRbaseline 1.28 (95% CI 1.13-1.44); HR10-year follow-up 1.17 (95% CI 0.91-1.50). Based on the baseline questionnaire, current HT users who met AHA recommendations for LTPA in 1995-1996 still had elevated stroke risk in the 20-year follow-up (HR 1.22, 95% CI 1.08-1.37). However, among current HT users who met AHA recommendations for LTPA at the 2005-2006 follow-up questionnaire, stroke risk was not elevated (HR 1.01, 95% CI 0.80-1.29). Evaluation of the 2 time points in concert further demonstrated that meeting AHA recommendations for LTPA at the most recent follow-up time point was required to reduce HT-related stroke risk.
Concurrent physical activity may attenuate the short-term increase in risk of stroke risk associated with HT use.
绝经后激素治疗（HT）会增加中风的风险。在这里，我们利用加利福尼亚教师研究的数据，评估休闲时间体育活动（LTPA）是否可以改变正在接受 HT 的女性的中风风险。
无中风既往史的女性加利福尼亚教育工作者（n = 118294）从 1995 年至 2015 年进行了中风终点随访。根据全州住院数据，4437 名女性患有缺血性中风（n = 3162；国际疾病分类[ICD]-9 433、434、436）或出血性中风（n = 1275；ICD-9 430-432，不包括 432.1）。LTPA 和 HT 使用情况在 2 个时间点进行评估（基线[1995-1996 年]和 10 年随访[2005-2006 年]）。使用美国心脏协会（AHA）的建议（> 150 分钟/周中度或> 75 分钟/周剧烈身体活动）评估 LTPA。使用多变量 Cox 比例风险模型，我们估计了 HT 使用与同时进行的 LTPA 与中风发生率之间的关联的风险比（HR）和 95%置信区间。
与从未使用 HT 的女性相比，当前正在使用 HT 且不符合 HT 使用时 AHA 关于 LTPA 建议的女性中风风险最高：基线 HR 1.28（95%CI 1.13-1.44）；10 年随访 HR 1.17（95%CI 0.91-1.50）。根据基线问卷，1995-1996 年符合 AHA 关于 LTPA 建议的当前 HT 用户在 20 年随访中仍存在较高的中风风险（HR 1.22，95%CI 1.08-1.37）。然而，在符合 2005-2006 年随访问卷中 AHA 关于 LTPA 建议的当前 HT 用户中，中风风险并未升高（HR 1.01，95%CI 0.80-1.29）。同时评估这两个时间点进一步表明，必须在最近的随访时间点符合 AHA 关于 LTPA 的建议，以降低与 HT 相关的中风风险。
同时进行的身体活动可能会减轻与 HT 使用相关的短期中风风险增加。
