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HRT not helpful for secondary prevention of cerebrovascular disease

WESTPORT, CT (Reuters Health) – Hormone replacement therapy does not reduce the risk of mortality or recurrence of stroke in postmenopausal women with cerebrovascular disease, according to a report in the October 25th issue of The New England Journal of Medicine.

In a double-blind protocol, Dr. Catherine M. Viscoli, of the Yale University School of Medicine in New Haven, Connecticut, and colleagues randomized 664 postmenopausal women (mean age 71 years) who had recently had an ischemic stroke or transient ischemic attack to 1 mg of estradiol-17-beta per day or placebo.

The team notes that 337 women received estradiol and 327 received placebo. Ninety-nine strokes or deaths occurred among the women in the estradiol group over a mean followup of 2.8 years, compared with 93 among women in the placebo group (relative risk for estradiol group 1.1).

"Estrogen therapy did not reduce the risk of death alone (relative risk 1.2) or the risk of nonfatal stroke (relative risk 1.0)," the investigators report.

The team did find that there was a higher risk for fatal stroke among women in the estradiol group compared with those in the placebo group (relative risk 2.9). In addition, women who received estradiol and experienced a nonfatal stroke had worse neurologic and functional deficits than women who received placebo.

The authors observed no significant differences between the groups in the incidence of transient ischemic attack or nonfatal myocardial infarction.

"Although we cannot rule out the possibility that estrogen 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%," Dr. Viscoli and colleagues explain.

"Our results indicate that estrogen therapy should not be initiated for the purpose of secondary prevention of cerebrovascular disease and add to the evolving body of evidence from clinical trials that do not show a benefit of estrogen for women with established vascular disease."

N Engl J Med 2001;345:1243-1249.

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