New national studies show combined hormone replacement therapy boosts stroke, dementia

th 258 patients instead of the 212 published last year," Heiss said. "The refined classification by neurologists allowed us to analyze the findings by types of stroke."

Heiss and colleagues found estrogen-plus-progestin therapy boosted the risk of strokes caused by clots but not by bleeding, he said. They found a 44 percent increase in ischemic stroke but no evidence of increased risk of hemorrhagic stroke.

"There was no subgroup of women who were not at increased risk of stroke if they were taking the combination therapy," he said. "The increased risk occurred in both in women with hypertension and those without it, although it appeared later in those with normal blood pressure and in those at low risk of stroke at baseline."

Stroke risk was also elevated in the combination therapy group among women with vasomotor symptoms, Heiss said.

"Overall, this paper indicates that the increased risk of ischemic stroke among women who were taking the hormone therapy is consistent with the reported increased risk in coronary heart disease and also with dementia attributable to an increased propensity to small strokes and cerebral infarcts (blood flow blockages)."

UNC participated in the Women's Health Initiative Memory Study, a substudy of the WHI Hormone Program, as one of the clinical examination sites, he said. Under the direction of Carol Murphy as principal investigator, the UNC site enrolled and examined 254 women aged 65 and older, as one of 39 sites involved in that investigation.

"Because of the potential harm and lack of benefit found, we recommend that older postmenopausal women not take the combination hormone therapy to prevent dementia, and we hope doctors will incorporate what we've learned in their recommendations to women," said lead author Shumaker. She and colleagues found that after four years of follow-up, 61 women were diagnosed with dementia, including 40 among the 2,229 in the hormone group compared with

Contact: David Williamson
University of North Carolina at Chapel Hill

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