This article is more than 5 years old. Information may no longer be current.
Postmenopausal HT reduces vascular dementia, Alzheimer’s disease mortality risks
Click Here to Manage Email Alerts
Postmenopausal women have a reduced risk for death from vascular dementia or Alzheimer’s disease with any use of estradiol-based hormone treatment, study data show.
Tomi S. Mikkola, MD, PhD, of the department of obstetrics and gynecology at Helsinki University Hospital in Finland, and colleagues identified 489,105 Finnish women using systemic HT from 1994 to 2009 from the nationwide drug reimbursement register to determine the risk for mortality attributable to vascular dementia or Alzheimer’s disease.
Through the follow-up from 1995 to 2009, 581 participants died from vascular dementia and 1,057 died from Alzheimer’s disease.
Initiation of HT before age 60 years was more likely among participants with subsequent vascular dementia compared with participants with subsequent Alzheimer’s disease (P < .001). Compared with deaths from Alzheimer’s disease, deaths from vascular dementia were more likely among HT users older than 90 years (P < .001).
Any use of HT for less than 5 years or at least 5 years reduced the risk for vascular dementia death by 37% to 39%. The risk for Alzheimer’s disease death was reduced by 15% to 19% with HT use exceeding 5 years.
There were no significant differences in risk reduction for death due to vascular dementia or Alzheimer’s disease with HT initiation at age younger than 60 years or at least 60 years. However, irrespective of initiation age, any use of HT was associated with a reduced risk for death due to Alzheimer’s disease.
“Estradiol-based systemic HT use was associated with a reduced risk of death both from [vascular dementia] and [Alzheimer’s disease], but the risk reduction was larger and appears sooner in [vascular dementia] than [Alzheimer’s disease],” the researchers wrote. “Our data imply that, in absolute numbers, of 10,000 women using any type of HT for over 5 years and with follow-up for 10 years, 10 fewer would die due to [vascular dementia] and five fewer due to [Alzheimer’s disease]. The vaginal estradiol use also appears protective against [vascular dementia] and [Alzheimer’s disease] death risk. These decreases in numbers of death are probably associated with much higher decreases of clinical presentation of these diseases.” – by Amber Cox
Disclosure: Mikkola reports receiving speaking and/or consultant fees from Mylan and Novo Nordisk.
Perspective
Back to Top
Walter A. Rocca
The study was conducted in a national Finnish registry and showed that estradiol-based hormone therapy was associated with a reduced risk for death from both vascular dementia and Alzheimer’s disease; however, the risk reduction was larger and appeared sooner in vascular dementia than in Alzheimer’s disease. The risk reduction was the same in women who started hormone therapy at age younger than 60 years or at age 60 years or older, and in women treated with estradiol only or with estradiol and progestin.
This is an important and well-designed study involving almost half a million women from a complete national population. The findings align with a sizable body of evidence that was reviewed by us in 2014 (Rocca WA, et al. Mol Cell Endocrinol. 2014;doi:10.1016/j.mce.2014.01.020). Population-based observational studies almost invariably have suggested that hormone therapy may reduce the risk for dementia. The majority of these women in the general population had undergone natural menopause and were treated for the relief of menopausal symptoms.
On the other hand, the Finnish study did not provide support for the timing hypothesis. One possible reason for the lack of evidence for the timing hypothesis may be the restriction to death for which dementia was the primary cause. Future analyses in this Finnish database should consider including all women who had dementia listed anywhere on the death certificate. These analyses would include the important segment of the population of women who developed dementia, but also developed another important cause of death, such as cardiovascular disease or cancer.
Disclosure: Rocca reports no relevant financial disclosures.
Click Here to Manage Email Alerts