Abstract WP107: Combined Estrogen and Progesterone Use is Associated with Increased Odds of Stroke in Young Women without Migraines: An Exploratory Analysis of the Colorado Claims Database

Introduction: Estrogen, alone or with progesterone, increases thromboembolic risk, especially with migraine with aura, smoking, or cardiovascular disease. Evidence on stroke risk from exogenous hormones across age groups is limited, particularly regarding migraine as a modifier. We conducted an exploratory analysis of stroke odds with sex steroid prescriptions among young women using Colorado claims data. Hypothesis: Exogenous sex steroids may affect stroke risk differently by age in young women, possibly due to age-related hormone fluctuations Methodology: We performed a secondary analysis of retrospective case–control data from Colorado’s All Payer Claims Database (2012–2019). Hormone exposure was defined as a sex steroid prescription within 1 year before index stroke in women aged 18–55. Stroke cases were matched to controls by age, sex, prestroke period, and insurance. Conditional logistic regression evaluated stroke odds for estrogen alone, progesterone alone, and combined exposure (concurrent or separate) in the year before stroke. Cohorts were stratified into 3 age groups, analyzed independent of migraine history and by migraine status. Models adjusted for socioeconomic status, language, cardiovascular and non-cardiovascular risk factors, menopause,&pregnancy/postpartum status Results: Our model included 1,369 cases and 4,083 matched controls, stratified by age. More controls had no risk factors than cases (Table 1). Women 18–34 and 35–44 on combined estrogen–progesterone had increased stroke odds (OR 1.91, 95%CI 1.23–2.95, p=0.004; OR 2.32, 95%CI 1.37–3.92, p=0.002), but not 45–55. Women 35–44 on estrogen alone also had increased odds (OR 2.61, 95%CI 1.28–5.33, p=0.009). Progesterone-only prescriptions were not associated with stroke. Migraine was associated with increased stroke odds: OR 2.96 (95%CI 2.02–4.33) for 18–34, OR 2.04 (95%CI 1.48–2.81) for 35–44, and OR 1.61 (95%CI 1.32–1.97) for 45–55 (all p<0.001) but when evaluted by hormone exposure did not increased odds across groups. Women without migraine, combined estrogen–progesterone increased stroke odds in all ages: OR 2.68 (95%CI 1.56–4.61) for 18–34, OR 3.23 (95%CI 1.65–6.32) for 35–44, and OR 1.62 (95%CI 1.01–2.60) for 45–55. Estrogen-only increased odds in 35–44 (OR 5.24, 95%CI 2.22–12.39) Conclusion: Combined estrogen–progesterone use were associated with higher stroke odds overall&in women without migraine. No association was seen between sex steroid and stroke in women with migraine