Hormone Replacement Therapy (Hrt) Does Not Reduce Stroke Risk

The Heart Estrogen-progestin Replacement Study (HERS) conducted by Dr. Joel A. Simon and colleagues at the VA Medical Centre in San Francisco found that HRT does not reduce the risk of stroke among postmenopausal women with coronary artery disease.

According to Dr. Simon this is the first large randomised clinical trial to examine the effect of HRT on risk of strokes in women already compromised by Coronary Artery Disease. HERS is a secondary Coronary Heart Disease prevention study among postmenopausal women i.e. in those with pre-existing Coronary Artery Disease.

2,763 women from 20 different centres in the USA received either a combination of oestrogen and progesterone (which is what HRT comprises of) or a placebo. The primary outcome of stroke and stroke deaths were studied in these subjects over a period of four years and 1 month and the numbers of women who suffered and did not suffer strokes were compared. It was found that 165 strokes occurred in 149 women (5%). HRT had no effect on the risk of non-fatal stroke, fatal stroke or transient ischaemic attack. The predisposing factors for stroke included high blood pressure, increasing age, diabetes, current smoking and atrial fibrillation. The researchers also found that there was no early increase in risk of stroke in the HRT assigned group followed by a later decrease.

In an accompanying editorial Drs. Tolbert and Oparil state that although the results seemed surprising in view of the well-documented protective action of oestrogen on the blood vessels it was obvious from the HERS study that it definitely has limitations in secondary prevention i.e. in the presence of existent heart disease. However as HRT does benefit post-menopausal women by its effects on menopausal symptoms, bone metabolisms and other conditions unrelated to the heart. Further reports on the primary prevention (i.e. in women who are overall healthy) trials of HRT are eagerly awaited.

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