Vaginal estradiol may be safe in women with prior ischemic stroke, study finds
A Danish study that matched women who had a recurrent ischemic stroke with controls found no significant association with current, recent, or past use of vaginal estradiol tablets.
Vaginal estradiol tablets were not associated with an increased rate of recurrent ischemic stroke in women with a history of ischemic stroke, according to the results of a nested case-control study.
Researchers used Danish registry data to evaluate women ages 45 years or older with no history of vaginal estrogen use before stroke diagnosis who had a first ischemic stroke in 2008 through 2017. Cases with recurrent ischemic stroke were matched 1:1 to controls based on birth year. Exposure to vaginal estradiol tablets was assessed using prescription data and categorized as current use (zero to three months before index), recent use (three to 24 months before index), and past use (>24 months before index). Results were published Aug. 21 by Stroke.
From a cohort of 56,642 women with a first-time stroke, researchers matched 3,353 cases with the same number of controls. The median age was 75 years. After adjustment for comorbidity, medications, income, and education, exposure to vaginal estradiol tablets was not associated with any significant increase in the rate of recurrent ischemic stroke (adjusted hazard ratios, 0.79 [95% CI, 0.52 to 1.20] [P=0.27] for current use; , 1.09 [95% CI, 0.73 to 1.63] [P=0.67] for recent use; and 1.48 [95% CI, 0.95 to 2.30] [P=0.08] for past use).
Among other limitations, the authors noted that they studied only vaginal estradiol tablets and that women who use and adhere to vaginal estradiol therapy may be healthier than nonadherent women, which could have biased their results. They concluded that in their nested case-control study, use of vaginal estradiol tablets was not associated with an increased rate of recurrent ischemic stroke in women with a history of ischemic stroke.