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No Alzheimer Protection in Estrogen Replacement
A DGReview of :"Postmenopausal Estrogen Replacement Therapy and the Risk of Alzheimer Disease"
Archives of Neurology
03/21/2001
By Elda Hauschildt
Using estrogen replacement therapy (ERT) after menopause does not reduce women's risk of developing Alzheimer's disease.
"Our findings indicate that ERT use in post-menopausal women is not associated with a substantially reduced risk of Alzheimer's disease and highlight the need for restraint in advocating post-menopausal ERT for this purpose," North American researchers report.
They found a risk estimate of 1.18 when all current ERT users in their study were compared with non-users.
"For ERT users who received the drug for five years or more compared to non-users, it was 1.05.
"Odds ratio estimates were similar in women who used unopposed estrogens and for those who also used progestins," the researchers note.
They estimate that 15 percent of older women will develop Alzheimer's disease during their lifetimes. This suggests that treatments that might reduce the risk are of great interest.
Researchers also explain that a sharp decline in estrogen levels characterise aging and menopause. Risks of developing osteoporosis and coronary artery disease, other conditions that affect post-menopausal women, appear to be decreased by use of ERT.
"Many basic neural mechanisms suggest that estrogen could beneficially affect the brain areas and processes involved in Alzheimer's disease," investigators point out. "However, biological plausibility alone does not establish a beneficial effect."
Investigators from the Framingham Heart Study and Boston University School of Medicine used a nested, population-based control study to determine whether ERT use is associated with a reduced Alzheimer's risk.
Data was drawn from the United Kingdom-based General Practice Research Database of 112,481 women who received ERT and 108,925 who did not.
Researchers identified 59 new cases of Alzheimer disease and 221 matched control subjects from the two cohorts.
They found that 15 (25 percent) of the women with newly diagnosed Alzheimer's were current estrogen users. A total of 53 (24 percent) of the controls used ERT.
"Odds ratios were similar for estrogen recipients who received estrogens alone and recipients who received combined estrogen-progestin treatment," investigators add.
Archives of Neurology, 2001; 58: 435-440.
"Postmenopausal Estrogen Replacement Therapy and the Risk of Alzheimer Disease"
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