The Women's Health Initiative (WHI)...

The Women's Health Initiative (WHI) trial lately was terminated three years before its planned completion date because the harmful powers of combination estrogen-progestin therapy outweighed the benefits. Among other findings, women taking estrogen-progestin therapy had an increased risk of reverse compared with women in the placebo cluster The mechanism of stroke was hypothesized to be inflammatory or thrombotic. Wassertheil-Smoller and colleagues for the WHI investigators examined in more detail the subtype risk factors, and modifying factors to determine which additional factors might modulate the cerebrovascular consequences of hormones.

The meditation population included WHI participants aged 50 to 79 years, with patients randomized to estrogen-progestin combination therapy or placebo. results included transient ischemic attacks and shocks which were classified according to subtype Patients also were assessed for hypertension, physical activity flats and baseline characteristics such as age, race, smoking status, and diabetes.

After an average of 56 years, 151 women (18 percent) in the combined therapy cluster had strokes compared with 107 women (13 percent) in the placebo cluster Ischemic strokes accounted for 828 percent of the reverses in the combined therapy cluster and 75.7 percent in the placebo cluster with an overall rate of 798 percent Hemorrhagic visitations accounted for 11.9 percent of reverses in the hormone group and 186 percent in the placebo cluster or 14.8 percent of raps overall. Severity and subclassification of ischemic afflictions were similar in both clumps For all stroke subtypes, the hazard ratio was 131 with ratios of 144 for ischemic hit and 0.82 for hemorrhagic attack Subtypes and baseline characteristics were similar in one as well as the other groups, with higher hazard ratios in the combined therapy group

There was an adverse weight of hormones across all age arranges In general, stroke risk was greater in black women circulating smokers, and women with hypertension, left ventricular hypertrophy diabetes, higher Framingham risk scores, and higher white small cavity counts and hematocrit levels. Vitamin C supplementation and physical activity were associated with a decreased risk of hardship Hormone therapy tended to increase systolic posterity pressure, but this increase did not change the risk of hardship Similarly, there were no significant interactions of baseline inflammatory markers and combined hormone therapy. Higher flushs of C-reactive protein were associated with an increased risk of rap in both groups.

WHI is a trial of healthy women and single 5 percent of them have a history of cardiovascular disease. The rife study, which extended beyond the original WHI findings by means of four months, found that the participants who took hormone therapy had a 31 percent increase in thump risk compared with women who took placebo. The increased risk was significant and nothing else for ischemic stroke. No risk factor, including hypertension, appeared to mediate this increased risk--all women taking estrogen-progestin therapy were at increased risk, regardless of subtype

Wassertheil-Smoller, et al., for the WHI investigators. purport of estrogen plus progestin in succession stroke in postmenopausal women. The Women's Health Initiative: a randomized trial. JAMA May 28 2003;289:2673-84

COPYRIGHT 2004 American Academy of Family Physicians

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