HRT
Linked to Increased Stroke Risk
Estrogen-progestin
combination appears to increase most women's risk, study concludes
The
first jolt came less than a year ago, when a national study revealed
that combined hormone therapy would not protect a woman from heart disease
as previously believed.
Now
a new analysis of that same research has found the estrogen-progestin
combination also appears to increase a woman's risk of stroke, in some
instances by as much as 70 percent. The increases were not just limited
to women with high blood pressure, which is a known risk factor for
stroke.
"We
saw an increase in stroke in all postmenopausal women across the board,
in healthy women and in women with high blood pressure, in younger women
and older women," says study author Sylvia Wassertheil-Smoller, a professor
of epidemiology and social medicine at Albert Einstein College of Medicine
in New York City. "There is no doubt in my mind that the use of the
estrogen/progestin combination should not even be considered as a strategy
for protecting a woman's health."
Smoller's
research is a re-analysis of data previously released from Women's Health
Initiative (WHI), a study designed to examine the health effects of
hormone replacement therapy (HRT). Although slated to last eight years,
part of the trial ended after five when sufficient data showed combined
hormone therapy not only failed to protect women, but also appeared
to increase health risks, particularly for cardiovascular disease. The
estrogen-only arm of the study is continuing.
The
new analysis was devised to see whether the same links appeared in relation
to stroke. The researchers looked at data on 8,506 women aged 50 to
79, all of whom received the combined estrogen/progestin therapy. The
control group was comprised of 8,102 women of the same age who took
a placebo.
The
study also took into consideration the women's ages, race, blood pressure
status, and baseline risk for stroke, none of which were detailed when
WHI was halted last year.
The
End Result
Overall,
researchers saw 133 strokes in the group taking the hormones, compared
to 93 in the control group. Women aged 50 to 59 who were taking hormones
had the most dramatic increases in strokes—as much as 70 percent
over the control group. Those aged 70 to 79 saw the least risk—only
26 percent.
The
most surprising finding of all, Smoller says, was that even in women
who had no history of heart or blood vessel disease, stroke rate climbed
by 40 percent when the combined hormone therapy was used.
Conclusions
Spark Controversy
Not
everyone agrees with the conclusions, which were presented at a recent
American Heart Association International Stroke Conference
in Phoenix.
For
gynecologist Dr. Steven Goldstein, the new analysis has serious flaws
and its conclusions are premature. Among the most obvious problems,
he says, is the lack of information concerning other risk factors for
stroke, particularly in women with normal blood pressure.
"The
study cannot tell us, for example, if these women might have had high
cholesterol, if they smoked, if they were overweight—all factors
that could have easily influenced the risk of stroke, irrespective of
hormone use," Goldstein says.
He
adds that unless researchers can say for certain that these other mitigating
factors were not present, then it is impossible to link the incidence
of stroke to hormone use in any kind of meaningful way.
"It
is very unfair to women to draw conclusions that create fear without
sufficient proof that there is even cause for alarm," he says.
While
physicians are not certain how or why the combination of estrogen and
progestin appears to increase stroke risks, Smoller believes individual
bio-markers and genetic fingerprints may play a role.
According
to the American Stroke Association, almost 100,000
women die of stroke each year, almost twice as many as from breast cancer.
Always
consult your physician for more information.
Online
Resources
American
College of Obstetricians and Gynecologists
American
Heart Association
American
Stroke Association
Centers
for Disease Control and Prevention (CDC)
National
Institutes of Health
National
Women's Health Information Center
|
March
2003
Estrogen-Progestin
Combination Appears to Increase Most Women's Risk, Study Concludes
The
End Result
Conclusions
Spark Controversy
New
Birth Control Pills Do Not Lower Stroke Risk
The
Nuisance of Hot Flashes
Online
Resources
Find
a St. John's Mercy Physician
In
Other Women's Health News:
New
Birth Control Pills Do Not Lower Stroke Risk
Despite
lower levels of estrogen, the new generations of birth control pills
double the risk of stroke for women who take them, a new study shows.
In
the first look at the risk of ischemic strokes from the latest generation
of oral contraceptives, Dutch researchers say the newest pills are
no safer than the older versions when it comes to clotting problems.
In fact, they argue, the third-generation pills may be more dangerous
than the second-generation ones.
The
history of oral contraceptives has been one of trial and error.
The
first generation of pills, introduced in 1960, was a mix of high doses
of estrogen and one of two other hormones, lynestrenol or norethisterone,
also known as progestogens. However, they increased the risk of clotting,
which can lead to ischemic stroke. The next version, released in the
1970s, contained markedly less estrogen and only the progestogen levonorgestrel.
This
combination also raised the risk of stroke, especially in smokers
and women with high blood pressure. In addition, women complained
of side effects from levonorgestrel, including acne, cholesterol problems,
and weight gain.
Hoping
for the best, pill makers issued yet another formula in the 1980s
that combined low estrogen levels with the less harsh progestogens
desogestrel or gestodene.
Third-generation
birth control pills have not been used in the United States long enough
to monitor women most at risk for stroke. However, Europe approved
them sooner, letting researchers there compare risks among all three
kinds of pills.
A
team led by Jeanet M. Kemmeren, an epidemiologist at University Medical
Center in Utrecht, looked for a link between oral contraceptives and
ischemic strokes in nearly 1,130 women, aged 18 to 49, of whom 203
had suffered one such attack.
Always
consult your physician for more information.
The
Nuisance of Hot Flashes
Reducing
Their Severity Without HRT
Hot
flashes—one of the more unpleasant symptoms of menopause—are
related to a drop in estrogen levels. Hormone replacement therapy
(HRT) had often been prescribed to prevent them, but with the recent
controversy surrounding HRT, other, symptom-relieving strategies are
offered below:
According
to the National Women's Health Information Center,
the following lifestyle changes may help reduce the severity or frequency
of your hot flashes:
-
Drink
a cool glass of water at the beginning of a hot flash.
-
Avoid
alcohol or caffeinated drinks. These chemicals increase the discomfort
of hot flashes.
-
Cut
down on red wine, chocolate, and aged cheeses. They contain a
chemical that can trigger hot flashes by affecting the brain's
temperature control.
-
Do
not smoke—as smoking often aggravates hot flashes.
-
Wear
loose, comfortable, cotton clothing.
-
At
home, lower your thermostat; at work, carry a small portable fan.
-
Sleep
with lightweight blankets.
-
Dress
in layers, so you can remove some clothing if you suddenly feel
hot.
Always
consult your physician for more information.
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