폐경과 뇌졸중 발생간의 관련성에 관한 코호트 연구

초록

Although an association of occurrence of menopause and subsequent estrogen deficiency with increased stroke has been postulated, studies on this association have not shown convincing results. To examine the association between age at menopause or time since menopause and the risk of stroke. This study was based on data from the Korean Elderly Pharmacoepidemiologic Cohort (KEPEC). This study population was restricted to 6,256 postmenopausal women aged 65 years or more who reported age at menopause and with no diagnosed stroke at baseline. The mean follow-up time was 4.85 years. Information on age at menopause, and other risk factors was obtained by mailed questionnaires. The cases of stroke were found from the claims data between 1993 and 1998, deaths cases due to stroke through the National Death Index and cases who reported having a stroke for follow-up period on questionnaire. After adjustment for age, hypertension, diabetes mellitus, physical activity, smoking, alcohol and Body Mass Index, the relative risks (RRs) across categories for age at menopause (<45,45-49,50-54, and 54< years) were 1.00(reference), 1.29 (95% confidence interval (CI), 0.71-2.35), 1.32 (95% CI, 0.74-2.37), 1.21 (95% CI, 0.62-2.36) in natural menopause group, and 1.08 (95% CI, 0.19-6.15), 1.83 (95% CI, 0.37-8.96), 0.32 (95% CI, 0.02-4.53) in the group with hysterectomy or ovariectomy. Also age at menopause and time since menopause were not significantly associated with cerebral infarction or hemorrhagic stroke in each of the two groups. Intervals between menopause and the onset of stroke, cerebral infarction or hemorrhagic stroke were longer for women with early menopause than for those with late menopause. These results show that age at menopause are not significantly associated with cerebral infarction or hemorrhagic stroke in women above age 65. To begin hormone therapy after 65 years may not be helpful for prevention of stroke in women with early menopause.