The Pharmaceutical Journal
Vol 270 No 7237 p258
22 February 2003

This article
Reprint
Photocopy

News summary

Related websites
American Stroke Association (more)
BMJ (bmj.com)

Hormone replacement therapy raises stroke risk for all women — with or without high blood pressure ...

Combination hormone replacement therapy (HRT) increases the risk of stroke in postmenopausal women of any age, whether or not they have hypertension, researchers report.

Dr Sylvia Wassertheil-Smoller, of the Albert Einstein College of Medicine in New York, and colleagues analysed data from the Women's Health Initiative study in which oestrogen plus progestogen was compared with placebo. The trial was stopped early after it was found that health risks seemed to exceed benefits in healthy women given HRT (PJ, 13 July 2002, p43).

At the time the trial was stopped, subgroup analyses by age, race, hypertension status and baseline risk had not been performed. However, the researchers now report that the increased risk of stroke associated with combination HRT extended across all age groups. Oestrogen plus progestogen was associated with a 70 per cent higher risk of stroke in women aged 50–59 years at baseline, compared with women in that age group who were given placebo, and a 26 per cent higher risk in those aged 70–79 years. In addition, excess risk was apparent in hypertensive women and in women with normal blood pressure (who had a 28 per cent higher risk than placebo controls). Women with no history of cardiovascular disease who received combination HRT had a 40 per cent higher risk of stroke than similarly healthy women given placebo. "Our finding is that [combined HRT] is absolutely not a strategy for primary prevention of cardiovascular disease," concluded Dr Wassertheil-Smoller.

Data were presented at the American Stroke Association's annual conference held in Phoenix, Arizona, last week.

... and increases the risk of heart disease in women with diabetes

Women with diabetes who use hormone replacement therapy (HRT) are at increased risk of death from all causes and of developing ischaemic heart disease, a new study suggests. The study also confirms that HRT confers no cardiovascular protection.

Researchers analysed data for 13,084 postmenopausal Danish nurses. They found that current users of HRT smoked more, consumed more alcohol but were slimmer and had a lower prevalence of diabetes than women who had never used HRT.

In current users, compared with never users, HRT had no protective effect on heart disease or myocardial infarction. However, women with diabetes who took HRT had an increased risk of death from all causes (hazard ratio 3.2), as well as an increased risk of developing ischaemic heart disease and MI compared with never users with diabetes.

The researchers say that the harmful effect of HRT among women with diabetes was not influenced by other risk factors for cardiovascular disease but could be explained by an influence on glycaemic control. The study is published in the BMJ (2003;326:426).