Stroke Risk from Menopausal and Contraceptive Hormones in Women 45-64 years of age

This project will assess the risk of hormone therapy (menopausal and contraceptives) in women 45-64 years of age on incident stroke and transient ischemic attack (TIA). Design: An age-matched nested case-control study is planned to assess the likelihood of stroke/TIA with various hormone therapy (HT) exposures. Subjects and Setting: Women without a history of prior stroke or TIA will be selected from a large population-based administrative health database. The MarketScan database is one of the nation’s largest commercial databases with diagnostic codes, laboratory results, and pharmacy claims for inpatient and outpatient care, a copy of which resides at our university. Incident Cases (outcomes): stroke/TIA cases occurring between 2012-2019 who have not had a stroke/TIA in the prior year. Controls: will be matched to each case by month of index date, age (+2 yrs) in a 10:1 ratio (also stroke/TIA free in year prior to index date). Exposure (interventions): Any HT exposure (including delivery route and formulation) and statin therapy exposures. Covariates: Co-morbidities and stroke risk factors, e.g., hypertension, smoking, diabetes, and age. Analysis: Conditional logistic regression models will test for differences in risk with HT and/or statin exposures, while controlling for relevant co-morbidities. Impact: Results may impact clinical care for peri- and post-menopausal women regarding use of menopausal and contraceptive hormones. Also if concurrent use of a statin significantly reduces risk of stroke associated with HT, results may impact the quality of life for thousands of women as they may re-consider HT to reduce menopausal symptoms