Question raised over benefit of HRT in cerebrovascular
disease
Oestrogen hormone replacement therapy does not reduce
the risk of stroke or death in post-menopausal women with cerebrovascular
disease, researchers say.
Dr Catherine Viscoli, Yale University, Connecticut,
and colleagues compared the effects of oestrogen therapy (1mg estradiol
a day) with placebo in 664 post-menopausal women who had recently had
an ischaemic stroke or transient ischaemic attack. The mean follow-up
period was 2.8 years.
The study found no significant difference between
the groups in the incidence of death or non-fatal stroke. However, death
resulting from stroke was more common in the estradiol group. "Although
we cannot rule out the possibility that oestrogen therapy has minimal
cerebrovascular benefits, our study had sufficient power to rule out reductions
in the risk of death or stroke of more than 20 per cent," the researchers
say.
They comment that oestrogen therapy might worsen
the injury caused by recurrent cerebral ischaemia. Oestrogen might increase
sensitivity to ischaemia or alternatively adverse events might result
from its pro-inflammatory effects. They conclude: "Our results indicate
that oestrogen therapy should not be initiated for the purpose of secondary
prevention of cerebrovascular disease."
The study is published in The New England Journal
of Medicine (2001;345:1243).
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