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Created:July 3, 2002
Latest Update: July 3 2002
jeannecurran@habermas.org
takata@uwp.edu

Menopause:
New study report on effectiveness of hormone therapy.

Teaching Essay Copyright: Jeanne Curran and Susan R. Takata and Individaul Authors, May 2002.
"Fair use" encouraged.

This essay is based on a New York Times article on hormone therapy: "A Hormone Therapy Study Finds No Benefits." By Denise Grady, Wednesday, July 3, 2002, at p. A14. Backup.

REFERENCES:

Journal of the American Medical Association

Cardiovascular Disease Outcomes During 6.8 Years of Hormone Therapy: Heart and Estrogen/Progestin Replacement Study Follow-up (HERS II)

[Author Information] Deborah Grady, MD, MPH; David Herrington, MD, MHS; Vera Bittner, MD; Roger Blumenthal, MD; Michael Davidson, MD; Mark Hlatky, MD; Judith Hsia, MD; Stephen Hulley, MD, MPH; Alan Herd, MD; Steven Khan, MD; L. Kristin Newby, MD; David Waters, MD; Eric Vittinghoff, PhD; Nanette Wenger, MD; for the HERS Research Group.

Postmenopausal hormone therapy and risk of stroke: The Heart and Estrogen-progestin Replacement Study (HERS).

Simon JA, Hsia J, Cauley JA, Richards C, Harris F, Fong J, Barrett-Connor E, Hulley SB.

General Internal Medicine Section, Medical Service, Veterans Affairs Medical Center, San Francisco, CA 94121, USA. jasimon@itsa.ucsf.edu

BACKGROUND: Observational studies have shown that postmenopausal hormone therapy may increase, decrease, or have no effect on the risk of stroke. To date, no clinical trial has examined this question. To investigate the relation between estrogen plus progestin therapy and risk of stroke among postmenopausal women, we analyzed data collected from the Heart & Estrogen-progestin Replacement Study (HERS), a secondary coronary heart disease prevention trial. METHODS AND RESULTS: Postmenopausal women (n=2763) were randomly assigned to take conjugated estrogen plus progestin or placebo. Primary outcomes for these analyses were stroke incidence and stroke death during a mean follow-up of 4.1 years. The number of women with strokes was compared with the number of women without strokes. A total of 149 women (5%) had 1 or more strokes, 85% of which were ischemic, resulting in 26 deaths. Hormone therapy was not significantly associated with risk of nonfatal stroke (relative hazard [RH] 1.18; 95% CI 0.83 to 1.66), fatal stroke (RH 1.61; 95% CI 0.73 to 3.55), or transient ischemic attack (RH 0.90; 95% CI 0.57 to 1.42). Independent predictors of stroke events included increasing age, hypertension, diabetes, current cigarette smoking, and atrial fibrillation. Black women were at increased risk compared with white women, and unexpectedly, body mass index was inversely associated with stroke risk. CONCLUSIONS: Hormone therapy with conjugated equine estrogen and progestin had no significant effect on the risk for stroke among postmenopausal women with coronary disease.

Nota bene: "Black women were at increased risk compared with white women, and unexpectedly, body mass index was inversely associated with stroke risk."

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