A Clinical Trial of Estrogen-Replacement Therapy after Ischemic Stroke

• Published in: The New England journal of medicine Vol. 345; no. 17; pp. 1243 - 1249
• Main Authors: Viscoli, Catherine M, Brass, Lawrence M, Kernan, Walter N, Sarrel, Philip M, Suissa, Samy, Horwitz, Ralph I
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 25-10-2001
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Brain Ischemia - drug therapy; Cardiovascular disease; Double-Blind Method; Endometrium - drug effects; Estradiol - adverse effects; Estradiol - therapeutic use; Estrogen Replacement Therapy - adverse effects; Female; Hormones. Endocrine system; Humans; Ischemic Attack, Transient - drug therapy; Medical sciences; Menopause; Middle Aged; Pharmacology. Drug treatments; Postmenopause; Secondary Prevention; Severity of Illness Index; Stroke - classification; Stroke - drug therapy; Stroke - mortality; Stroke - prevention & control; Studies; Treatment Outcome; Women; Human; Nervous system diseases; Stroke; Relapse; Secondary; Mortality; Menopause; Estrogen; Cardiovascular disease; Controlled therapeutic trial; Estradiol; Cerebral disorder; Vascular disease; Prevention; Chemotherapy; Randomization; Treatment; Central nervous system disease; Double blind study; Evolution; Female; Cerebrovascular disease
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMoa010534

Some observational studies have suggested that women who are receiving estrogen-replacement therapy have a lower risk of stroke and death than others. The Women's Estrogen for Stroke Trial was a double-blind, placebo-controlled trial of estradiol-17β in 664 women with a recent cerebrovascular event. Estrogen therapy did not reduce the risk of stroke or death in these women and was associated with a borderline increase in the risk of fatal stroke; this therapy was also associated with adverse effects on the endometrium.
In this double-blind, placebo-controlled trial, in 664 women, estrogen therapy did not reduce the risk of stroke or death. This therapy was also associated with adverse effects on the endometrium.
Although many observational studies have linked postmenopausal estrogen therapy with a reduced risk of vascular disease, especially morbidity and mortality from cardiovascular causes,
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concern has persisted that these findings may be attributable not to estrogen therapy but to other differences between users and nonusers of such therapy.
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Although estrogen therapy may have favorable effects on lipid metabolism,
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coagulation,
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,
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and vascular tone,
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,
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it may also have adverse prothrombotic and proinflammatory effects.
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,
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In 1998, the findings of the first placebo-controlled, randomized clinical trial of hormone-replacement therapy for the secondary prevention of cardiac disease in postmenopausal women, the Heart and . . .