Preventative Effects Of Hormone Replacement Therapy Challenged.(Brief Article)

2001 NOV 15 - (NewsRx.com & NewsRx.net) -- Estrogen hormone replacement therapy does not reduce the risk of stroke or death in postmenopausal women who have already had a stroke or a transient ischemic attack (TIA), according to a report from the first randomized, placebo-controlled clinical trial of estrogen therapy for secondary prevention of cerebrovascular disease.

Previous observational studies have suggested that estrogen replacement therapy may reduce the risk of stroke and death in postmenopausal women. However, it was not clear whether the apparent benefits of estrogen among women in those studies were due to the hormone therapy or other factors.

The new randomized, double-blind, placebo-controlled study, called the Women's Estrogen for Stroke Trial (WEST), was designed to resolve this question. The study, led by Ralph I. Horwitz, MD, of the Yale University School of Medicine, was funded by the National Institute of Neurological Disorders and Stroke (NINDS) and was published in the October 25, 2001, issue of The New England Journal of Medicine.

"The good news is that we have taken a lot of guesswork out of treating women with strokes. The benefits from estrogen that we hoped for are not there to balance the risks," says John R. Marler, MD, NINDS associate director for clinical trials.

Based on this finding, the investigators say, estrogen therapy should not be prescribed for the purpose of preventing a second stroke or death in postmenopausal women. Postmenopausal women who are already taking estrogen or who wish to take it for other reasons should seek the advice of their personal physicians to decide whether to continue or start therapy.

Estrogen has rarely been prescribed specifically for stroke prevention, says Lawrence M. Brass, MD, of the Yale University School of Medicine, principal neurologist on the study. However, it has been widely prescribed for prevention of osteoporosis (thinning of the bones) and relief of menopausal symptoms such as hot flashes.

The researchers enrolled 664 postmenopausal women with an average age of 71 years who had experienced an ischemic stroke or a TIA within the previous 90 days. Ischemic strokes and TIAs result from blockages in the vessels that supply blood to the brain. Participants were given a number of initial assessments, including the NIH Stroke Scale (NIHSS) of neurological impairment and the Barthel index of functional ability in activities of daily living.