Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Estrogen-alone hormone therapy could increase risk of dementia in older women

23.06.2004


Older women using estrogen-alone hormone therapy could be at a slightly greater risk of developing dementia, including Alzheimer’s disease (AD), than women who do not use any menopausal hormone therapy, according to a new report by scientists with the Women’s Health Initiative Memory Study (WHIMS). The scientists also found that estrogen alone did not prevent cognitive decline in these older women. These findings from WHIMS appear in the June 23/30, 2004, Journal of the American Medical Association*.
"These studies further support last year’s recommendations that menopausal hormone therapy should not be used to prevent cognitive decline or dementia in older postmenopausal women," stated Judith A. Salerno, MD, MS, Deputy Director of the National Institute on Aging (NIA). "Women should follow the Food and Drug Administration’s recommendation that those who want to use menopausal hormone therapy to control their menopausal symptoms should use it at the lowest effective dose for the shortest time necessary."

The latest findings were reported by WHIMS Principal Investigator Sally A. Shumaker, PhD, Wake Forest University School of Medicine, and her colleagues at the 39 study sites. This research was funded by Wyeth Pharmaceuticals, which manufactures PremarinTM, the conjugated equine estrogens used in this trial, and Wake Forest University Baptist Medical Center. WHIMS is a substudy of the Women’s Health Initiative (WHI) Hormone Trial, which is funded by the National Institutes of Health (NIH) at the Department of Health and Human Services (DHHS). The National Institute on Aging (NIA), a component of NIH, has been involved in reviewing the current findings as the lead NIH institute on age-related cognitive change and dementia.


The WHI Hormone Trial using estrogen plus progestin was stopped early in July 2002 when researchers found an increased risk of breast cancer, along with greater risks of heart disease, stroke, and blood clots, and determined that these risks outweighed the benefits of reduced risks of hip fracture and colorectal cancer. In May 2003, WHIMS investigators reported the results of the estrogen plus progestin part of their memory substudy**. They found that estrogen plus progestin increased the risk of probable dementia in women 65 and older and did not preserve cognitive function. This part of WHIMS was also stopped in July 2002.

At the end of February 2004, the remaining parts of the WHI Hormone Trial and WHIMS, the estrogen-alone components, were halted because results were showing an increased risk of stroke and no reduction in the risk of heart disease in the women using estrogen alone. Scientists further believed that continuing the study until its planned conclusion next year would probably not add new information. In April 2004, the WHI investigators reported that they found an increased risk of blood clots, but no significant effect on breast or colorectal cancer and also a reduced risk of fractures in those women using estrogen alone.

Now, the WHIMS scientists have evaluated the cognition and dementia data from the estrogen-alone part of the trial. Some 2,947 women age 65 to 79 at the beginning of the trial received estrogen alone (a daily dose of 0.625 mg of PremarinTM) or a placebo. (The women received estrogen alone because they had all had hysterectomies at some time before beginning the study. A progestin is used with estrogen in menopausal hormone therapy in any woman with a uterus to prevent thickening and, sometimes, cancer of the lining of the uterus, the endometrium. Because the uterus is removed in a hysterectomy, there is no need for progestin when women who have had hysterectomies use menopausal hormone therapy.)

Participants were determined to be dementia free before they were enrolled in WHIMS. At the beginning and then annually for the more than 5-year average duration of the trial, WHIMS participants were evaluated to determine if they might have developed dementia or mild cognitive impairment (MCI). All women received the Modified Mini Mental State Exam (3MSE), and those suspected of having dementia also received an extensive clinical evaluation by a specialist physician.

At the end of the study, the risk of dementia in the estrogen-alone group was 49% higher than the risk in women using the placebo. That is, among 10,000 women using conjugated equine estrogens, 37 could be expected to develop dementia, compared to 25 in 10,000 women using the placebo--12 extra cases of dementia in every 10,000 women using estrogen alone each year. This increased risk was not statistically significant.

Last year WHIMS scientists reported a 105% increase in the risk of dementia in older women using estrogen plus progestin compared to those using a placebo. That means, on average, each year in 10,000 women over age 65 using estrogen plus progestin there might be 45 cases of dementia compared to 22 cases in 10,000 older women on placebo.

Almost half of the dementia cases in the estrogen-alone study--46% in older women using estrogen alone and 47% of those in older women using the placebo--were Alzheimer’s disease (AD). Similarly, in the estrogen plus progestin study, 50% of the cases in older women using estrogen plus progestin and 57% of those in older women using placebo were classified as AD.

A second article on general cognitive function*** from Mark A. Espeland, PhD, and other WHIMS investigators appears in the same issue of JAMA. It reports that beginning estrogen-alone hormone therapy after age 65 can have a small negative effect on overall cognitive abilities and that this negative effect may be greater in women with existing cognitive problems. The differences in scores on cognitive testing for the estrogen-alone and placebo groups were statistically significant, but the differences were so small that they are not considered clinically relevant by the investigators.

As with the earlier WHI and WHIMS result reports, these increases in risk must be viewed in perspective. Significant increases in risk are important for public health officials who are concerned with large groups in the population, where a small increase could have health implications for millions of people. For an individual woman, however, the increased risk is still quite small. (A detailed discussion of risk is presented in the NIA Fact Sheet, Understanding Risk: What Do Those Headlines Really Mean?, available online at http://www.niapublications.org/engagepages/risk.asp).

Further, these findings relate to women age 65 and older taking this particular estrogen-alone hormone therapy. The cognitive risks and benefits for younger women using PremarinTM or other estrogen formulations are unknown. Any younger woman who is considering menopausal hormone therapy because of her menopausal symptoms should talk to her doctor about how the various Women’s Health Initiative study findings relate to her own medical history and treatment.

Karin Kolsky | EurekAlert!
Further information:
http://www.nih.gov
http://www.nih.gov/PHTindex.htm

More articles from Health and Medicine:

nachricht New malaria analysis method reveals disease severity in minutes
14.08.2017 | University of British Columbia

nachricht New type of blood cells work as indicators of autoimmunity
14.08.2017 | Instituto de Medicina Molecular

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Fizzy soda water could be key to clean manufacture of flat wonder material: Graphene

Whether you call it effervescent, fizzy, or sparkling, carbonated water is making a comeback as a beverage. Aside from quenching thirst, researchers at the University of Illinois at Urbana-Champaign have discovered a new use for these "bubbly" concoctions that will have major impact on the manufacturer of the world's thinnest, flattest, and one most useful materials -- graphene.

As graphene's popularity grows as an advanced "wonder" material, the speed and quality at which it can be manufactured will be paramount. With that in mind,...

Im Focus: Exotic quantum states made from light: Physicists create optical “wells” for a super-photon

Physicists at the University of Bonn have managed to create optical hollows and more complex patterns into which the light of a Bose-Einstein condensate flows. The creation of such highly low-loss structures for light is a prerequisite for complex light circuits, such as for quantum information processing for a new generation of computers. The researchers are now presenting their results in the journal Nature Photonics.

Light particles (photons) occur as tiny, indivisible portions. Many thousands of these light portions can be merged to form a single super-photon if they are...

Im Focus: Circular RNA linked to brain function

For the first time, scientists have shown that circular RNA is linked to brain function. When a RNA molecule called Cdr1as was deleted from the genome of mice, the animals had problems filtering out unnecessary information – like patients suffering from neuropsychiatric disorders.

While hundreds of circular RNAs (circRNAs) are abundant in mammalian brains, one big question has remained unanswered: What are they actually good for? In the...

Im Focus: RAVAN CubeSat measures Earth's outgoing energy

An experimental small satellite has successfully collected and delivered data on a key measurement for predicting changes in Earth's climate.

The Radiometer Assessment using Vertically Aligned Nanotubes (RAVAN) CubeSat was launched into low-Earth orbit on Nov. 11, 2016, in order to test new...

Im Focus: Scientists shine new light on the “other high temperature superconductor”

A study led by scientists of the Max Planck Institute for the Structure and Dynamics of Matter (MPSD) at the Center for Free-Electron Laser Science in Hamburg presents evidence of the coexistence of superconductivity and “charge-density-waves” in compounds of the poorly-studied family of bismuthates. This observation opens up new perspectives for a deeper understanding of the phenomenon of high-temperature superconductivity, a topic which is at the core of condensed matter research since more than 30 years. The paper by Nicoletti et al has been published in the PNAS.

Since the beginning of the 20th century, superconductivity had been observed in some metals at temperatures only a few degrees above the absolute zero (minus...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Call for Papers – ICNFT 2018, 5th International Conference on New Forming Technology

16.08.2017 | Event News

Sustainability is the business model of tomorrow

04.08.2017 | Event News

Clash of Realities 2017: Registration now open. International Conference at TH Köln

26.07.2017 | Event News

 
Latest News

A Map of the Cell’s Power Station

18.08.2017 | Life Sciences

Engineering team images tiny quasicrystals as they form

18.08.2017 | Physics and Astronomy

Researchers printed graphene-like materials with inkjet

18.08.2017 | Materials Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>