Hormone Replacement Therapy and Stroke

Despite major progress in treatment and prevention, stroke remains the leading cause of disability and the third leading cause of death, surpassed only by heart disease and cancer, in the United States.1 An estimated 500 000 to 600 000 first and 100 000 recurrent strokes occur each year, and '160 000 of these are fatal.2 Among stroke survivors, the burden of long-term disability is great. In the Framingham Heart Study, 71% had impairments that affected their ability to work in their previous capacity and 31% needed help in caring for themselves.3 Stroke rates in women increase sharply with age, doubling in each successive decade after the age of 55 years. Stroke incidence is substantially lower in younger women than in age-matched men, but it tends to equalize in the two sexes in the postmenopausal years.1 Thus, stroke is a major health problem for postmenopausal women and one that merits aggressive preventive strategies.