Estudio casos controles
430 casos de AVE y 905 controles sanas.
La actividad ovárica por menos de 34 años se asocia a un riesgo relativo mayor en 51% de sufrir AVE, pero la menarquia antes de los 13 años también y en similar proporción.
Risk of ischemic stroke and lifetime estrogen exposure.
de Lecinana MA, Egido JA, Fernandez C, Martinez-Vila E, Santos S, Morales A, Martinez E, Pareja A, Alvarez-Sabin J, Casado I; PIVE Study Investigators of the Stroke Project of the Spanish Cerebrovascular Diseases Study Group.
Department of Neurology, University Hospital Ramon y Cajal, Ctra de Colmenar Km 9,100, 28034 Madrid, Spain. mariaalonsoleci@telefonica.net
BACKGROUND: Estrogen loss has been related to higher incidence of stroke in postmenopausal women, but randomized trials have demonstrated an increased risk of stroke in women receiving hormone replacement therapy (HRT).
OBJECTIVE: To assess the relationship between exposure to endogenous ovarian hormones and the risk of noncardioembolic ischemic stroke.
METHODS: We conducted a multicenter, age-matched, case-control study in postmenopausal women (case: nonembolic ischemic stroke; control: no stroke) comparing duration of ovarian activity or lifetime estrogen exposure, which was defined as age at menarche to age at menopause. Embolic cardiopathy and unreliable gynecologic data were exclusion criteria. Cardiovascular disease risk factors were recorded. The relationships of the principal variables to the risk of stroke were assessed using a conditional logistic regression analysis.
RESULTS: There were 430 cases and 905 controls in the study.
In the multivariate analysis,
hypertension (odds ratio [OR]: 2.73; 95% CI: 2.09 to 3.58; p < 0.0001),
diabetes (OR: 3.38; 95% CI: 2.53 to 4.52; p < 0.0001),
hyperlipidemia (OR: 1.31; 95% CI: 1.01 to 1.7; p = 0.045), l
ifespan of ovarian activity <34 years (OR: 1.51; 95% CI: 1.13 to 2.03; p = 0.005), and
menarche at <13 years of age (OR 1.49; 95% CI: 1.15 to 1.92; p = 0.002)
were independently related to an increased risk of stroke.
Obesity (OR: 0.73; 95% CI: 0.56 to 0.95; p = 0.021) was related to a lower risk of stroke.
CONCLUSIONS: Longer lifetime exposure to ovarian estrogens may protect against noncardioembolic ischemic stroke. However, a very early age of exposure onset could be disadvantageous.
