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(Stroke. 2001;32:606.)
© 2001 American Heart Association, Inc.
Original Contributions |
Hormonal Factors and Risk of Aneurysmal Subarachnoid Hemorrhage
An International Population-Based, Case-Control Study
From the Clinical Trials Research Unit, University of Auckland (New Zealand) (C.N.M., C.A.); Department of Public Health, University of Western Australia, Perth (K.J., G.H.); Stroke Unit, Department of Neurology, Royal Perth Hospital (Western Australia) (G.H.); and Royal Hobart Hospital, Tasmania, Australia (D.D.).
Correspondence to Dr Cliona Ni Mhurchu, Clinical Trials Research Unit, Faculty of Medicine and Health Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand. E-mail c.nimhurchu{at}ctru.auckland.ac.nz
Background and Purpose—Subarachnoid hemorrhage (SAH) is more common in women than in men, but the role of hormonal factors in its etiology remains uncertain. The aim of this study was to examine the relationship between hormonal factors and risk of SAH in women.
Methods—This was a prospective, multicenter, population-based, case-control study performed in 4 major urban centers in Australia and New Zealand. Two hundred sixty-eight female cases of first-ever aneurysmal SAH occurred during 1995–1998. Controls were 286 frequency-matched women from the general population of each center. Outcome measures included risk of SAH associated with use of oral contraceptive pills (OCPs), hormone replacement therapy (HRT), and various endogenous hormonal factors including menstrual patterns, parity, age at birth of first child, and breast-feeding practices.
Results—Cases and controls did not differ with regard to menstrual and reproductive history except in age at birth of first child, where older age was associated with reduced risk of SAH (odds ratio [OR], 0.63; 95% CI, 0.43, 0.91). Relative to never use of HRT, the adjusted OR for ever use of HRT was 0.64 (95% CI, 0.41, 0.98), which did not alter significantly after further adjustment for possible confounding factors. Borderline evidence of an inverse association was detected for past use of HRT (adjusted OR, 0.59; 95% CI, 0.30, 1.13) and current use of HRT (adjusted OR, 0.67; 95% CI, 0.40, 1.13), but there was no evidence of an association for use of OCPs (adjusted OR, 0.97; 95% CI, 0.58, 1.60).
Conclusions—The risks of SAH are lower in women whose first pregnancy is at an older age and women who have ever used HRT but not OCPs. The findings suggest an independent etiologic role for hormonal factors in the pathogenesis of aneurysmal SAH and provide support for a protective role for HRT on risk of SAH in postmenopausal women.
Editorial Comment
The Gender Gap in Aneurysmal Subarachnoid Hemorrhage
Departments of Neurology and Epidemiology, University of Washington, Seattle, Washington
Division of Epidemiology, Department of Health Research & Policy, Stanford University Stanford, California
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