HRT
HRT AND HEART DISEASE
In a study by Duke University researchers the use of HRT
in postmenopausal women with heart disease is questioned.
The researchers, led by Dr. Karen Alexander, performed an
observational analysis of 1857 postmenopausal women with
coronary artery disease. They found that of 111 patients
who started HRT after a myocardial infarction 33% were subsequently
hospitalised for unstable angina within a year. No deaths
were reported in this group however.
Women who were taking HRT before their first myocardial
infarction and who continued it after a myocardial infarction
also had a high rate of hospitalisation for unstable angina.
A total of 413 patients fell into this category: 21% of
them were admitted for unstable angina within the first
year, and four (1%) of them died.
In contrast, of the 1,333 women who were never on HRT, only
17% were hospitalised for unstable angina in the year after
their heart attack, and 4% of them died. The death rates
were not considered statistically significant across the
groups.
Dr. Alexander said: "While hormone use has benefits
and may still be cardioprotective in women without heart
disease, women who have heart disease probably should not
start using them. We also have no reason to suggest that
women stop using hormones if they develop heart disease."
The Duke University study is the second to challenge the
conventional medical wisdom which assumes that HRT is nearly
always cardioprotective.
BMJ no.7186 p753
EFFECT OF OESTROGEN ON BRAIN ACTIVATION PATTERNS IN POSTMENOPAUSAL
WOMEN DURING WORKING MEMORY TASKS
Declining oestrogen levels characterise menopause with
effects on a range of systems including, in addition to
the reproductive system, the cardiovascular and skeletal
systems. Furthermore, there is evidence that oestrogen affects
basic neural processes. Therefore, a study was carried out
to investigate the effects of oestrogen on brain activation
patterns in post-menopausal women as they performed verbal
and non-verbal working memory tasks.
The study group consisted of 46 post-menopausal women aged
33 to 61 years. The trial consisted of a 21-day treatment
with conjugated equine oestrogens, 1.25 mg/d, randomly crossed
over with identical placebo and a 14-day washout between
treatments. Brain activation patterns were measured using
functional magnetic resonance imaging during tasks involving
verbal and non-verbal working memory. It was found that
treatment with oestrogen increased activation in the inferior
parietal lobule during storage of verbal material and decreased
activation in the inferior parietal lobule during storage
of non-verbal material. Oestrogen also increased activation
in the right frontal gyrus during retrieval tasks, accompanied
by greater left-hemisphere activation during encoding. Oestrogen
did not affect actual performance of the verbal and non-verbal
memory tasks.
Thus, oestrogen in a therapeutic dosage alters brain activation
patterns in post-menopausal women in specific brain regions
during the performance of the sorts of memory function that
are called upon frequently during any given day. These results
suggest that oestrogen affects brain organisation for memory
in post-menopausal women.
Shaywitz, S.E. et al
J.A.M.A. 1999, 281 (13) 1197-1202
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