Hormone Replacement Therapy Does Not Increase Risk.(of stroke in post menopausal women with heart disease)

2001 FEB 15 - (NewsRx.com) -- Hormone replacement therapy with estrogen and progestin does not alter the risk of stroke in post menopausal women with heart disease.

Researchers with the Heart and Estrogen-progestin Replacement Study (HERS) found that the hormone therapy did not significantly increase or decrease the risk of stroke or transient ischemic attacks (TIAs), sometimes called "ministrokes," in women who received it.

"HERS is the first clinical trial of postmenopausal hormone therapy to examine whether such therapy affects the risk of TIAs and stroke. The bottom line is that the decision to use or not use hormone therapy should be based on its known risks and benefits, and not on any presumed effect on stroke risk," said Joel A. Simon, MD, University of California, San Francisco, and lead author of the study, published in Circulation.

An editorial in the journal calls the findings "surprising" when one considers the well-documented role of estrogen as a vasoprotectant, and that hormone replacement therapy is known to reduce various fats in the blood. Also, animal studies have suggested that estrogen can protect against strokes, said Todd Tolbert, MD, and Suzanne Oparil, MD, University of Alabama at Birmingham, the editorial's authors.

Stroke is a leading cause of death and disability, particularly among older women, many of whom use the estrogen-progestin combination to treat the symptoms of menopause and for the prevention of osteoporosis.

Previous studies that assessed the therapy's stroke risk had yielded mixed results. Some showed a benefit, some found no benefit, and the highly regarded Framingham Heart Study suggested an increased risk of stroke, at least among cigarette smokers. None of these studies, however, was a randomized, controlled clinical trial.

The HERS trial was primarily designed to examine whether the estrogen -progestin combination would prevent a recurrent heart attack or hospitalization for unstable (worsening) angina in postmenopausal women with heart disease. However, HERS also included a number of secondary goals, one of which was to determine the therapy's impact on stroke and TIAs.