Effect of Estrogen Plus Progestin on Stroke in Postmenopausal Women: The Women’s Health Initiative—A Randomized Trial

Wassertheil‐Smoller, Sylvia; Hendrix, Susan L.; Limacher, Marian C.; Heiss, Gerardo; Kooperberg, Charles; Baird, Alison E.; Curb, J. David; Black, Henry R.; Rossouw, Jacques E.; Aragaki, Aaron K.; Safford, Monika; Stein, Evan A.; Laowattana, Somchai; Mysiw, W. Jerry

doi:10.1097/01.ogx.0000093671.39203.32

Cited by 145 publications

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“…In the Rotterdam trial, Atherosclerosis Risk In Communities (ARIC) studied elevated levels of Lp-PLA2 that were associated with an adjusted HR of 2.0-2.1 for stroke [62,63]. However, in the Women's Health Initiative, the relative increase in stroke risk with elevated levels of Lp-PLA2 was less, at 1.07 (95% CI 1.01-1.14) [64]. CRP levels have also been shown to be predictive of stroke risk [62].…”

Section: Biomarkers Of Final Infarct Volume and Outcomementioning

confidence: 99%

Blood Biomarkers of Ischemic Stroke

2011

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This review provides a summary of the protein and RNA biomarkers that have been studied for the diagnosis and assessment of ischemic stroke. Many of the biomarkers identified relate to the pathophysiology of ischemic stroke, including ischemia of CNS tissue, acute thrombosis and inflammatory response. These biomarkers are summarized by their intended clinical application in ischemic stroke including diagnosis, prediction of stroke severity and outcome, and stratification of patients for stroke therapy. Among the biomarkers discussed are recent whole genome studies using RNA expression profiles to diagnose ischemic stroke and stroke etiology. Though many candidate blood based biomarkers for ischemic stroke have been identified, none are currently used in clinical practice. With further well designed study and careful validation, the development of blood biomarkers to improve the care of patients with ischemic stroke may be achieved.

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Section: Biomarkers Of Final Infarct Volume and Outcomementioning

confidence: 99%

Blood Biomarkers of Ischemic Stroke

2011

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“…However, in a placebo-controlled trial of HRT with 16 608 postmenopausal women, the estrogen plus progestin arm was related to a small (B1 mm Hg) increase is systolic BP compared with placebo. 2 Similar to oral contraceptives, HRT containing drospirenone seems to reduce BP due to its antimineralocorticoid receptor effects. The combination of 17-b-estradiol and drospirenone was tested in 27 Overall, HRT induces, if any, small changes in BP and should not preclude HRT use in either normotensive or hypertensive women.…”

Section: Hormone Replacement Therapy and Bpmentioning

confidence: 99%

“…Prevalence and severity of hypertension increase markedly with advancing age in women, such that a higher percentage of women than men have high BP after 65 years. [1][2][3][4][5] Furthermore, BP control is more difficult to achieve in older women. Data from the Framingham Heart Study showed gender differences in BP control rates and in the pattern of antihypertensive medications prescribed.…”

Section: Introductionmentioning

confidence: 99%

Hypertension in women

Pimenta

2011

Hypertens Res

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Hypertension is an important modifiable risk factor for cardiovascular (CV) morbidity and mortality, and a highly prevalent condition in both men and women. However, the prevalence of hypertension is predicted to increase more among women than men. Combined oral contraceptives (COCs) can induce hypertension in a small group of women and, increase CV risk especially among those with hypertension. Both COC-related increased CV risk and blood pressure (BP) returns to pretreatment levels by 3 months of its discontinuation. The effects of menopause and hormone replacement therapy (HRT) on BP are controversial, and COCs and HRT containing the new generation progestin drospirenone are preferred in women with established hypertension. Despite the high incidence of cancer in women, CV disease remains the major cause of death in women and comparable benefit of antihypertensive treatment have been demonstrated in both women and men. Hypertension Research (2012) 35, 148-152; doi:10.1038/hr.2011; published online 1 December 2011Keywords: blood pressure; treatment; women INTRODUCTIONHypertension is an important modifiable risk factor for cardiovascular (CV) morbidity and mortality, and a highly prevalent condition in both men and women. Blood pressure (BP) is generally higher in men than in women regardless of age. Mean systolic BP in the overall population increases progressively throughout adult life in both men and women. During early adulthood mean systolic BP is higher in men than women, but the subsequent rate of rise in BP is steeper for women than men. Prevalence and severity of hypertension increase markedly with advancing age in women, such that a higher percentage of women than men have high BP after 65 years. 1-5 Furthermore, BP control is more difficult to achieve in older women. Data from the Framingham Heart Study showed gender differences in BP control rates and in the pattern of antihypertensive medications prescribed. 3 An age-related decrease in BP control rates were more pronounced in women than in men. Among the oldest participants with hypertension, only 23% of women (vs. 38% of men) were controlled to BP o140/90 mm Hg. Treatment with thiazide diuretics was also more frequent among women than men (38 vs. 23%). It is unknown whether the age-related decline in BP control among women is related to true treatment resistance because of biological factors or to inappropriate drug choices in the clinical setting.This article discusses practical aspects related to hypertension in women and some topics are discussed in detail in separate articles in this special review edition.

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“…Early studies of unopposed estrogen replacement in women report a reduction in risk for cardiovascular disease (Hurn and Brass, 2003). Yet, recent prospective studies of women on prolonged, daily combined hormone replacement therapy (HRT) of conjugated equine estrogens (CEE; 0.625 mg) and medroxyprogesterone acetate (MPA; 2.5 mg) for primary prevention (Rossouw et al, 2002), or on 17b-estradiol alone for secondary stroke prevention (Viscoli et al, 2001), reported no protection or adverse effects of the hormones on women's risk of stroke (Wassertheil-Smoller et al, 2003).…”

Section: Introductionmentioning

confidence: 99%

Effects of Combined Oral Conjugated Estrogens and Medroxyprogesterone Acetate on Brain Infarction Size after Experimental Stroke in Rat

Littleton-Kearney

Klaus

Hurn

2005

J Cereb Blood Flow Metab

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The reason that estrogen is strongly protective in various estrogen-deficient animal models while seemingly detrimental in postmenopausal women remains unclear. It hypothesized that prolonged oral medroxyprogesterone (MPA) plus oral conjugated equine estrogens (CEE) diminishes estrogen ability to reduce stroke damage in the rodent stroke model. To test the hypothesis, we fed ovariectomized rats CEE or MPA, or a combination of CEE and MPA (CEP), before inducing 120 min of reversible focal stroke, using the intraluminal filament model. After 22 h reperfusion, the brains were harvested and infarction volumes were quantified. Treatment with CEE alone or with CEP reduced cortical infarction volume. However, CEP failed to provide ischemic protection in subcortical regions. It was concluded that CEE alone, or with CEP, is neuroprotective in the cortex, but interactive effects between the hormones may counteract CEE beneficial effects in subcortical brain regions.

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Effect of Estrogen Plus Progestin on Stroke in Postmenopausal Women: The Women’s Health Initiative—A Randomized Trial

Cited by 145 publications

References 0 publications

Blood Biomarkers of Ischemic Stroke

Blood Biomarkers of Ischemic Stroke

Hypertension in women

Effects of Combined Oral Conjugated Estrogens and Medroxyprogesterone Acetate on Brain Infarction Size after Experimental Stroke in Rat

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