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LIBRIS Formathandbok  (Information om MARC21)
FältnamnIndikatorerMetadata
00008461naa a2200637 4500
001oai:DiVA.org:uu-337231
003SwePub
008171221s2017 | |||||||||||000 ||eng|
009oai:DiVA.org:umu-143590
009oai:lup.lub.lu.se:1578e5d0-8c4b-4a09-9279-80ad438cebfc
009oai:prod.swepub.kib.ki.se:137186751
0247 a https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-3372312 URI
0247 a https://doi.org/10.1371/journal.pmed.10024452 DOI
0247 a https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-1435902 URI
0247 a https://lup.lub.lu.se/record/1578e5d0-8c4b-4a09-9279-80ad438cebfc2 URI
0247 a http://kipublications.ki.se/Default.aspx?queryparsed=id:1371867512 URI
040 a (SwePub)uud (SwePub)umud (SwePub)lud (SwePub)ki
041 a engb eng
042 9 SwePub
072 7a ref2 swepub-contenttype
072 7a art2 swepub-publicationtype
1001 a Carrasquilla, Germán Du Karolinska Institutet,Karolinska Institute4 aut
2451 0a Postmenopausal hormone therapy and risk of stroke :b A pooled analysis of data from population-based cohort studies.
264 c 2017-11-17
264 1b Public Library of Science (PLoS),c 2017
338 a print2 rdacarrier
520 a BACKGROUND: Recent research indicates a favourable influence of postmenopausal hormone therapy (HT) if initiated early, but not late, on subclinical atherosclerosis. However, the clinical relevance of timing of HT initiation for hard end points such as stroke remains to be determined. Further, no previous research has considered the timing of initiation of HT in relation to haemorrhagic stroke risk. The importance of the route of administration, type, active ingredient, and duration of HT for stroke risk is also unclear. We aimed to assess the association between HT and risk of stroke, considering the timing of initiation, route of administration, type, active ingredient, and duration of HT.METHODS AND FINDINGS: Data on HT use reported by the participants in 5 population-based Swedish cohort studies, with baseline investigations performed during the period 1987-2002, were combined in this observational study. In total, 88,914 postmenopausal women who reported data on HT use and had no previous cardiovascular disease diagnosis were included. Incident events of stroke (ischaemic, haemorrhagic, or unspecified) and haemorrhagic stroke were identified from national population registers. Laplace regression was employed to assess crude and multivariable-adjusted associations between HT and stroke risk by estimating percentile differences (PDs) with 95% confidence intervals (CIs). The fifth and first PDs were calculated for stroke and haemorrhagic stroke, respectively. Crude models were adjusted for age at baseline only. The final adjusted models included age at baseline, level of education, smoking status, body mass index, level of physical activity, and age at menopause onset. Additional variables evaluated for potential confounding were type of menopause, parity, use of oral contraceptives, alcohol consumption, hypertension, dyslipidaemia, diabetes, family history of cardiovascular disease, and cohort. During a median follow-up of 14.3 years, 6,371 first-time stroke events were recorded; of these, 1,080 were haemorrhagic. Following multivariable adjustment, early initiation (<5 years since menopause onset) of HT was associated with a longer stroke-free period than never use (fifth PD, 1.00 years; 95% CI 0.42 to 1.57), but there was no significant extension to the time period free of haemorrhagic stroke (first PD, 1.52 years; 95% CI -0.32 to 3.37). When considering timing as a continuous variable, the stroke-free and the haemorrhagic stroke-free periods were maximal if HT was initiated approximately 0-5 years from the onset of menopause. If single conjugated equine oestrogen HT was used, late initiation of HT was associated with a shorter stroke-free (fifth PD, -4.41 years; 95% CI -7.14 to -1.68) and haemorrhagic stroke-free (first PD, -9.51 years; 95% CI -12.77 to -6.24) period than never use. Combined HT when initiated late was significantly associated with a shorter haemorrhagic stroke-free period (first PD, -1.97 years; 95% CI -3.81 to -0.13), but not with a shorter stroke-free period (fifth PD, -1.21 years; 95% CI -3.11 to 0.68) than never use. Given the observational nature of this study, the possibility of uncontrolled confounding cannot be excluded. Further, immortal time bias, also related to the observational design, cannot be ruled out.CONCLUSIONS: When initiated early in relation to menopause onset, HT was not associated with increased risk of incident stroke, regardless of the route of administration, type of HT, active ingredient, and duration. Generally, these findings held also for haemorrhagic stroke. Our results suggest that the initiation of HT 0-5 years after menopause onset, as compared to never use, is associated with a decreased risk of stroke and haemorrhagic stroke. Late initiation was associated with elevated risks of stroke and haemorrhagic stroke when conjugated equine oestrogen was used as single therapy. Late initiation of combined HT was associated with haemorrhagic stroke risk.
650 7a MEDICIN OCH HÄLSOVETENSKAPx Klinisk medicinx Kardiologi0 (SwePub)302062 hsv//swe
650 7a MEDICAL AND HEALTH SCIENCESx Clinical Medicinex Cardiac and Cardiovascular Systems0 (SwePub)302062 hsv//eng
650 7a MEDICIN OCH HÄLSOVETENSKAPx Hälsovetenskapx Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi0 (SwePub)303022 hsv//swe
650 7a MEDICAL AND HEALTH SCIENCESx Health Sciencesx Public Health, Global Health, Social Medicine and Epidemiology0 (SwePub)303022 hsv//eng
7001 a Frumento, Paolou Karolinska Institutet,Karolinska Institute4 aut
7001 a Berglund, Anitau Karolinska Institutet,Karolinska Institute4 aut
7001 a Borgfeldt, Christeru Lund University,Lunds universitet,Obstetrik och gynekologi, Lund,Sektion V,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Obstetrics and Gynaecology (Lund),Section V,Department of Clinical Sciences, Lund,Faculty of Medicine,Skåne University Hospital4 aut0 (Swepub:lu)gyn-cbo
7001 a Bottai, Matteou Karolinska Institutet,Karolinska Institute4 aut
7001 a Chiavenna, Chiarau Karolinska Institute4 aut
7001 a Eliasson, Matsu Umeå University,Umeå universitet,Medicin4 aut0 (Swepub:umu)mael0021
7001 a Engström, Gunnaru Lund University,Lunds universitet,Kardiovaskulär forskning - epidemiologi,Forskargrupper vid Lunds universitet,Cardiovascular Research - Epidemiology,Lund University Research Groups4 aut0 (Swepub:lu)smi-gen
7001 a Hallmans, Göranu Umeå University,Umeå universitet,Näringsforskning4 aut0 (Swepub:umu)goha0001
7001 a Jansson, Jan-Håkanu Umeå University,Umeå universitet,Medicin4 aut0 (Swepub:umu)jaja0006
7001 a Magnusson, Patrik Ku Karolinska Institutet,Karolinska Institute4 aut
7001 a Nilsson, Peter M.u Lund University,Lunds universitet,Internmedicin - epidemiologi,Forskargrupper vid Lunds universitet,Internal Medicine - Epidemiology,Lund University Research Groups4 aut0 (Swepub:lu)medf-pni
7001 a Pedersen, Nancy Lu Karolinska Institutet,Karolinska Institute4 aut
7001 a Wolk, Alicjau Karolinska Institutet,Karolinska Institute,Uppsala universitet,Ortopedi4 aut0 (Swepub:uu)alwol516
7001 a Leander, Karinu Karolinska Institutet,Karolinska Institute4 aut
7102 a Karolinska Institutetb Karolinska Institute4 org
7730 t PLoS Medicined : Public Library of Science (PLoS)g 14:11q 14:11x 1549-1277x 1549-1676
8564 u https://journals.plos.org/plosmedicine/article/file?id=10.1371/journal.pmed.1002445&type=printable
8564 u https://doi.org/10.1371/journal.pmed.1002445y Fulltext
8564 u https://umu.diva-portal.org/smash/get/diva2:1171041/FULLTEXT01.pdfx primaryx Raw objecty fulltext:print
8564 u http://dx.doi.org/10.1371/journal.pmed.1002445x freey FULLTEXT
8564 8u https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-337231
8564 8u https://doi.org/10.1371/journal.pmed.1002445
8564 8u https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-143590
8564 8u https://lup.lub.lu.se/record/1578e5d0-8c4b-4a09-9279-80ad438cebfc
8564 8u http://kipublications.ki.se/Default.aspx?queryparsed=id:137186751

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