The Women's Health Initiative could not have detected cardioprotective effects of starting hormone therapy during the menopausal transition

Naftolin, Frederick; Taylor, Hugh S.; Karas, Richard H.; Brinton, Eliot A.; Newman, Isadore; Clarkson, Thomas B.; Mendelsohn, Michael E.; Løbo, Rogerio A.; Judelson, Debra R.; Nachtigall, Lila E.; Heward, Christopher B.; Hecht, Harvey S.; Jaff, Michael R.; Harman, S. Mitchell

doi:10.1016/j.fertnstert.2004.02.095

Cited by 147 publications

(95 citation statements)

References 11 publications

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“…As reviewed recently by Henderson, Clark and others working in the area [164,[176][177][178][179][180][181][182], several caveats/potential limitations to the study should be noted. First, as reviewed recently by Clark [176], one of the major problems with the interpretation of the study was that the authors emphasized the use of relative risks rather than absolute risks.…”

Section: Alzheimer's Diseasementioning

confidence: 98%

Neurotrophic and neuroprotective actions of estrogen: Basic mechanisms and clinical implications

et al. 2007

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Estrogen is an important hormone signal that regulates multiple tissues and functions in the body. This review focuses on the neurotrophic and neuroprotective actions of estrogen in the brain, with particular emphasis on estrogen actions in the hippocampus, cerebral cortex and striatum. Sex differences in the risk, onset and severity of neurodegenerative disease such as Alzheimer's disease, Parkinson's disease and stroke are well known, and the potential role of estrogen as a neuroprotective factor is discussed in this context. The review assimilates a complex literature that spans research in humans, non-human primates and rodent animal models and attempts to contrast and compare the findings across species where possible. Current controversies regarding the WHI (Women's Health Initiative) study, its ramifications, concerns and the new studies needed to address these concerns are also addressed. Signaling mechanisms underlying estrogen-induced neuroprotection and synaptic plasticity are reviewed, including the important concepts of genomic versus nongenomic mechanisms, types of estrogen receptor involved and their subcellular targeting, and implicated downstream signaling pathways and mediators. Finally, a multicellular mode of estrogen action in the regulation of neuronal survival and neurotrophism is discussed, as are potential future directions for the field.

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Section: Alzheimer's Diseasementioning

confidence: 98%

Neurotrophic and neuroprotective actions of estrogen: Basic mechanisms and clinical implications

et al. 2007

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“…Thus, it is possible that starting HRT in women during perimenopause may prove more beneficial. 11 In addition, the many previous studies that showed positive effects of HRT on CVD in postmenopausal women were usually small cohorts of women who were mostly healthy and active, were of middle socioeconomic status or higher, followed good dietary regimens, and did not have diabetes. In contrast, the cohort in WHI, although excluding women who had previous CV events, included all types of postmenopausal women independent of body weight and activity.…”

Section: Estrogens and Cardiovascular Diseasementioning

confidence: 99%

Sex Steroids, Cardiovascular Disease, and Hypertension

2005

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“…Deve-se destacar que o estudo WHI não tinha poder estatístico suficiente para evidenciar redução de risco cardiovascular na população entre 50 e 59 anos de idade. De fato, seria necessário um número cerca de dez vezes superior de mulheres incluídas no estudo, nessa faixa etária, para observar tal efeito (41).…”

Section: Doença Tromboembólica E Cardiovascularunclassified

Terapia hormonal na menopausa: quando não usar

Spritzer

Wender

2007

Arq Bras Endocrinol Metab

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RESUMOA menopausa corresponde à cessação permanente da menstruação, conseqüente à perda da função folicular ovariana ou à remoção cirúrgica dos ovários. A idade média para ocorrência da menopausa natural gira em torno de 50 anos. A deficiência estrogênica decorrente da menopausa está associada com sintomas vasomotores, atrofia urogenital, declínio cognitivo, assim como a um aumento no risco de doenças crônico-degenerativas, aterosclerose e doença cardiovascular, osteoporose e doença de Alzheimer. A estrogenioterapia permanece sendo o tratamento mais efetivo para o manejo dos sintomas vasomotores e atrofia urogenital. Em mulheres com útero presente, a progesterona natural ou os progestogênios devem ser associados ao tratamento com estradiol para antagonizar os efeitos proliferativos deste hormônio sobre o endométrio e anular o risco de hiperplasia/carcinoma endometrial. Por outro lado, em determinadas condições clínicas, a terapia hormonal não é recomendada ou é mesmo contra-indicada. Neste artigo, focalizamos criticamente essas situações clínicas em que não se deve indicar a terapia hormonal na menopausa. Menopause is defined as the permanent cessation of menses, as a result of the loss of ovarian follicular function or of surgical removal of ovaries. The mean age for occurrence of natural menopause is around 50 years. Estrogen deficiency has been associated with vasomotor symptoms, urogenital atrophy, and cognitive impairment, as well as increased risk of chronic degenerative diseases such as osteoporosis and Alzheimer's disease. Estrogen therapy remains the most effective treatment for the management of vasomotor symptoms and urogenital atrophy. Progesterone or progestins should be added to estrogen treatment in women with uterus, in order to antagonize the estrogen-induced endometrial proliferation. In turn, in specific clinical conditions hormone therapy is not recommended. In the present article, the authors critically focus these clinical conditions in which hormone therapy should not be used.

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The Women's Health Initiative could not have detected cardioprotective effects of starting hormone therapy during the menopausal transition

Cited by 147 publications

References 11 publications

Neurotrophic and neuroprotective actions of estrogen: Basic mechanisms and clinical implications

Neurotrophic and neuroprotective actions of estrogen: Basic mechanisms and clinical implications

Sex Steroids, Cardiovascular Disease, and Hypertension

Terapia hormonal na menopausa: quando não usar

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