Postmenopausal hormone therapy and subclinical cerebrovascular disease The WHIMS-MRI Study

Division of Public Health Sciences, Wake Forest University Health Sciences, Winston-Salem, NC 27157, USA.
Neurology (Impact Factor: 8.29). 02/2009; 72(2):125-34. DOI: 10.1212/01.wnl.0000339036.88842.9e
Source: PubMed


The Women's Health Initiative Memory Study (WHIMS) hormone therapy (HT) trials reported that conjugated equine estrogen (CEE) with or without medroxyprogesterone acetate (MPA) increases risk for all-cause dementia and global cognitive decline. WHIMS MRI measured subclinical cerebrovascular disease as a possible mechanism to explain cognitive decline reported in WHIMS.
We contacted 2,345 women at 14 WHIMS sites; scans were completed on 1,424 (61%) and 1,403 were accepted for analysis. The primary outcome measure was total ischemic lesion volume on brain MRI. Mean duration of on-trial HT or placebo was 4 (CEE+MPA) or 5.6 years (CEE-Alone) and scans were conducted an average of 3 (CEE+MPA) or 1.4 years (CEE-Alone) post-trial termination. Cross-sectional analysis of MRI lesions was conducted; general linear models were fitted to assess treatment group differences using analysis of covariance. A (two-tailed) critical value of alpha = 0.05 was used.
In women evenly matched within trials at baseline, increased lesion volumes were significantly related to age, smoking, history of cardiovascular disease, hypertension, lower post-trial global cognition scores, and increased incident cases of on- or post-trial mild cognitive impairment or probable dementia. Mean ischemic lesion volumes were slightly larger for the CEE+MPA group vs placebo, except for the basal ganglia, but the differences were not significant. Women assigned to CEE-Alone had similar mean ischemic lesion volumes compared to placebo.
Conjugated equine estrogen-based hormone therapy was not associated with a significant increase in ischemic brain lesion volume relative to placebo. This finding was consistent within each trial and in pooled analyses across trials.

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    • "Risk factors for Alzheimer's disease and vascular disease overlap substantially (Stampfer, 2006), and cerebrovascular disease potentiates clinical manifestations of Alzheimer neuropathology (Schneider et al., 2007). However, here is no direct evidence that adverse vascular consequences of hormone therapy led to dementia in the WHIMS trials (Coker et al., 2009). Clinical evidence supporting the critical window hypothesis for cognitive outcomes remains limited. "
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