Association of ischemic stroke, hormone therapy, and right to left shunt in postmenopausal women

Nancy C. Greep, David S. Liebeskind, Rubine Gevorgyan, Tam Truong, Bennett Cua, Chi Hong Tseng, David William Dodick, Bart M Demaerschalk, David E. Thaler, Jonathan M. Tobis

Research output: Contribution to journalArticle

Abstract

Background Postmenopausal hormone therapy (HT) increases the risk of venous thrombosis and ischemic stroke. Objectives We postulated that HT might increase the risk of ischemic stroke by promoting venous clots that travel to the brain through a right to left shunt (RLS). Methods A total of 2,389 records were studied. After eliminating the premenopausal patients, and those with TIAs and non-ischemic strokes, the medical records of 1846 postmenopausal women hospitalized at four institutions for ischemic stroke were reviewed to identify those who had undergone an adequate study to assess for RLS. The proportion of women with a shunt in users and non-users of HT was compared in stroke patients and in a reference population consisting of postmenopausal women undergoing elective cardiac catheterization. Results There were 363 (20%) records that had complete data and were included in the analysis. A shunt was more prevalent in patients with a cryptogenic stroke than in patients with a stroke of known cause (55/88 (63%) vs. 53/275 (19%), P<0.001). In patients with a stroke of known cause, the frequency of a shunt was similar to that in reference women 31/136 (23%), and the proportion of women with a shunt was similar in non-users and current users of HT (14% vs. 20%, P=0.40). However, among patients with a cryptogenic stroke, the prevalence of a shunt was 1.5 times higher in current users than non-users of HT (82% vs. 56%, P=0.04). Conclusions Approximately 23% of older women have a RLS. HT in these women may increase the risk of ischemic stroke by promoting paradoxical embolism.

Original languageEnglish (US)
Pages (from-to)479-485
Number of pages7
JournalCatheterization and Cardiovascular Interventions
Volume84
Issue number3
DOIs
StatePublished - Sep 1 2014

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Stroke
Hormones
Therapeutics
Paradoxical Embolism
Cardiac Catheterization
Venous Thrombosis
Medical Records
Brain
Population

Keywords

  • cryptogenic stroke
  • hormone therapy
  • patent foramen ovale

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Greep, N. C., Liebeskind, D. S., Gevorgyan, R., Truong, T., Cua, B., Tseng, C. H., ... Tobis, J. M. (2014). Association of ischemic stroke, hormone therapy, and right to left shunt in postmenopausal women. Catheterization and Cardiovascular Interventions, 84(3), 479-485. https://doi.org/10.1002/ccd.25431

Association of ischemic stroke, hormone therapy, and right to left shunt in postmenopausal women. / Greep, Nancy C.; Liebeskind, David S.; Gevorgyan, Rubine; Truong, Tam; Cua, Bennett; Tseng, Chi Hong; Dodick, David William; Demaerschalk, Bart M; Thaler, David E.; Tobis, Jonathan M.

In: Catheterization and Cardiovascular Interventions, Vol. 84, No. 3, 01.09.2014, p. 479-485.

Research output: Contribution to journalArticle

Greep, Nancy C. ; Liebeskind, David S. ; Gevorgyan, Rubine ; Truong, Tam ; Cua, Bennett ; Tseng, Chi Hong ; Dodick, David William ; Demaerschalk, Bart M ; Thaler, David E. ; Tobis, Jonathan M. / Association of ischemic stroke, hormone therapy, and right to left shunt in postmenopausal women. In: Catheterization and Cardiovascular Interventions. 2014 ; Vol. 84, No. 3. pp. 479-485.
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AU - Greep, Nancy C.

AU - Liebeskind, David S.

AU - Gevorgyan, Rubine

AU - Truong, Tam

AU - Cua, Bennett

AU - Tseng, Chi Hong

AU - Dodick, David William

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AU - Thaler, David E.

AU - Tobis, Jonathan M.

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N2 - Background Postmenopausal hormone therapy (HT) increases the risk of venous thrombosis and ischemic stroke. Objectives We postulated that HT might increase the risk of ischemic stroke by promoting venous clots that travel to the brain through a right to left shunt (RLS). Methods A total of 2,389 records were studied. After eliminating the premenopausal patients, and those with TIAs and non-ischemic strokes, the medical records of 1846 postmenopausal women hospitalized at four institutions for ischemic stroke were reviewed to identify those who had undergone an adequate study to assess for RLS. The proportion of women with a shunt in users and non-users of HT was compared in stroke patients and in a reference population consisting of postmenopausal women undergoing elective cardiac catheterization. Results There were 363 (20%) records that had complete data and were included in the analysis. A shunt was more prevalent in patients with a cryptogenic stroke than in patients with a stroke of known cause (55/88 (63%) vs. 53/275 (19%), P<0.001). In patients with a stroke of known cause, the frequency of a shunt was similar to that in reference women 31/136 (23%), and the proportion of women with a shunt was similar in non-users and current users of HT (14% vs. 20%, P=0.40). However, among patients with a cryptogenic stroke, the prevalence of a shunt was 1.5 times higher in current users than non-users of HT (82% vs. 56%, P=0.04). Conclusions Approximately 23% of older women have a RLS. HT in these women may increase the risk of ischemic stroke by promoting paradoxical embolism.

AB - Background Postmenopausal hormone therapy (HT) increases the risk of venous thrombosis and ischemic stroke. Objectives We postulated that HT might increase the risk of ischemic stroke by promoting venous clots that travel to the brain through a right to left shunt (RLS). Methods A total of 2,389 records were studied. After eliminating the premenopausal patients, and those with TIAs and non-ischemic strokes, the medical records of 1846 postmenopausal women hospitalized at four institutions for ischemic stroke were reviewed to identify those who had undergone an adequate study to assess for RLS. The proportion of women with a shunt in users and non-users of HT was compared in stroke patients and in a reference population consisting of postmenopausal women undergoing elective cardiac catheterization. Results There were 363 (20%) records that had complete data and were included in the analysis. A shunt was more prevalent in patients with a cryptogenic stroke than in patients with a stroke of known cause (55/88 (63%) vs. 53/275 (19%), P<0.001). In patients with a stroke of known cause, the frequency of a shunt was similar to that in reference women 31/136 (23%), and the proportion of women with a shunt was similar in non-users and current users of HT (14% vs. 20%, P=0.40). However, among patients with a cryptogenic stroke, the prevalence of a shunt was 1.5 times higher in current users than non-users of HT (82% vs. 56%, P=0.04). Conclusions Approximately 23% of older women have a RLS. HT in these women may increase the risk of ischemic stroke by promoting paradoxical embolism.

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KW - patent foramen ovale

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