Peer Review #3 of "Symptomatic menopausal transition and risk of subsequent stroke (v0.2)"

Abstract

Objective. To examine the long-term risk of stroke in women who have experienced symptomatic menopausal transition. Methods. In this nationwide, population-based cohort study conducted from January 1, 2000 to December 31, 2013, we identified 22058 women with no prior history of stroke, who experienced symptomatic menopausal transition at ≥ 45 years of age. Moreover, 22058 women without symptomatic menopause were matched by propensity scores and enrolled as a comparison group. The propensity score was calculated by using all characteristic variables of each subject, including demographics (age and monthly income), comorbidities (hypertension, hyperlipidemia, diabetes mellitus, obesity, chronic kidney disease, coronary artery disease, congestive heart failure, chronic obstructive pulmonary disease, dysrhythmia, peripheral artery occlusive disease), Charlson's comorbidity index score, clinic visit frequency, and longterm medications (antihypertensives, antidiabetic agents, statins, antiplatelets, aspirin, warfarin, and hormone replacement therapy). The primary endpoint was the development of stroke after the onset of symptomatic menopausal transition. The Fine and Gray's proportional subhazards model was performed to assess the association between symptomatic menopausal transition and subsequent stroke. All subjects were followed up until December 31, 2013. Results. During a mean follow-up of 8.5 years (standard deviation 4.7 years, maximum 14 years), 2274 (10.31%) women with symptomatic menopausal transition and 1184 (5.37%) matched comparison participants developed stroke. The incidence rates were 11.17 per 1000 person-years in the symptomatic menopausal transition group compared with 8.57 per 1000 person-years in the comparison group. The risk of developing stroke was significantly higher in women with symptomatic menopausal transition (crude subhazard ratio, 1.31; 95% confidence interval, 1.22 to 1.41;