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Risk of Stroke Decreases With Higher Lifetime Exposure to Estrogen
Women with higher lifetime cumulative estrogen exposure may have a lower risk of stroke overall as well as ischemic stroke and intracerebral hemorrhage subtypes, according to study findings published in Neurology.
“Our study suggests that higher estrogen levels due to a number of reproductive factors, including a longer reproductive life span and using hormone therapy or contraceptives, are linked to a lower risk of ischemic stroke and intracerebral hemorrhage,” said study author Peige Song, PhD, of the Zhejiang University School of Medicine in Hangzhou, China. “These findings might help with new ideas for stroke prevention, such as considering screenings for people who have a short lifetime exposure to estrogen.”
The prospective cohort study included 122,939 postmenopausal women, median age 58 years, living in China and without prior stroke at baseline. Participants provided information on lifestyle factors, medical history, and reproductive health information, such as age at first menstruation and start of menopause, number of pregnancies and miscarriages, and oral contraceptive use, for the study.
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Over a median follow-up of 9 years, 15,139 women had a stroke. Among them, 12,853 had an ischemic stroke, 2580 had intracerebral hemorrhage, and 269 had subarachnoid hemorrhage, health insurance and disease registry data showed.
Women in the quartile with the longest reproductive life span (36 reproductive years or more) had a 5% lower risk of stroke than women in the quartile with the shortest reproductive life span (up to 31 reproductive years) after researchers adjusted for age, smoking, physical activity, high blood pressure, and other factors that affect stroke risk.
By stroke subtype, women in the quartile with the longest reproductive life span had a 5% lower risk of ischemic stroke and a 13% lower risk of intracerebral hemorrhage compared with women in the quartile with the shortest reproductive life span, according to the study.
The study also considered other factors affecting estrogen levels, such as number of births, use of oral contraceptives, and length of breastfeeding. Higher estrogen levels, investigators learned, led to a lower risk of all stroke overall, ischemic stroke, and intracerebral hemorrhage.
“Estrogen exposure throughout life could potentially be a useful indicator of a person’s risk of different types of stroke following menopause,” said Dr Song. “However, more research is needed on the biological, behavioral, and social factors that may contribute to the link between estrogen exposure and stroke risk across a woman’s lifespan.”
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