Can biomarkers identify women at increased stroke risk? The Women's Health Initiative Hormone Trials - PubMed (original) (raw)
Can biomarkers identify women at increased stroke risk? The Women's Health Initiative Hormone Trials
Charles Kooperberg et al. PLoS Clin Trials. 2007.
Abstract
Objective: The Women's Health Initiative hormone trials identified a 44% increase in ischemic stroke risk with combination estrogen plus progestin and a 39% increase with estrogen alone. We undertook a case-control biomarker study to elucidate underlying mechanisms, and to potentially identify women who would be at lower or higher risk for stroke with postmenopausal hormone therapy (HT).
Design: The hormone trials were randomized, double-blind, and placebo controlled.
Setting: The Women's Health Initiative trials were conducted at 40 clinical centers in the United States.
Participants: The trials enrolled 27,347 postmenopausal women, aged 50-79 y.
Interventions: We randomized 16,608 women with intact uterus to conjugated estrogens 0.625 mg with medroxyprogesterone acetate 2.5 mg daily or placebo, and 10,739 women with prior hysterectomy to conjugated estrogens 0.625 mg daily or placebo.
Outcome measures: Stroke was ascertained during 5.6 y of follow-up in the estrogen plus progestin trial and 6.8 y of follow-up in the estrogen alone trial.
Results: No baseline clinical characteristics, including gene polymorphisms, identified women for whom the stroke risk from HT was higher. Paradoxically, women with higher baseline levels of some stroke-associated biomarkers had a lower risk of stroke when assigned to estrogen plus progestin compared to placebo. For example, those with higher IL-6 were not at increased stroke risk when assigned to estrogen plus progestin (odds ratio 1.28) but were when assigned to placebo (odds ratio 3.47; p for difference = 0.02). Similar findings occurred for high baseline PAP, leukocyte count, and D-dimer. However, only an interaction of D-dimer during follow-up interaction with HT and stroke was marginally significant (p = 0.03).
Conclusions: Biomarkers did not identify women at higher stroke risk with postmenopausal HT. Some biomarkers appeared to identify women at lower stroke risk with estrogen plus progestin, but these findings may be due to chance.
Conflict of interest statement
Competing Interests MC participated in three meetings as a consultant for Pharmacia, Novartis, and Merck on topics related to hormone therapies or selective estrogen receptor modulators in 2001 and 2003. JGR has received to date: Grants from Abbott, Andrx Labs, Astra-Zeneca, Atherogenics, Bristol-Myers Squibb, GlaxoSmithKline, Hoffman La Roche, Merck, Pfizer, Procter & Gamble, Sankyo, Schering-Plough, Takeda, and Wyeth Ayerst; Speaker honoraria for education programs from Bristol-Myers Squibb, Merck, and Pfizer; Honoraria from Reliant; Consultant/Advisory Board for Bristol -Myers Squibb, Merck, Pfizer, Proliant, Wellmark, and American Emu Association.
Figures
Figure 1. Women's Health Initiative Hormone Trials
CEE, conjugated equine estrogens; MPA, medroxyprogestrone acetate.
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References
- Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: Principal results from the Women's Health Initiative randomized controlled trial. JAMA. 2002;288:321–333. - PubMed
- Anderson GL, Limacher M, Assaf AR, Bassford SA, Black H, et al. Effects of conjugated equine estrogen on postmenopausal women with hysterectomy: The Women's Health Initiative randomized controlled trial. JAMA. 2004;291:1701–1712. - PubMed
- Wassertheil-Smoller S, Hendrix SL, Limacher M, Heiss G, Kooperberg C, et al. Effect of estrogen plus progestin on stroke in postmenopausal women: The Women's Health Initiative: A randomized trial. JAMA. 2003;289:2673–2684. - PubMed
- Hendrix SL, Wassertheil-Smoller S, Johnson KC, Howard BV, Kooperberg C, et al. Effects of conjugated equine estrogen on stroke in the Women's Health Initiative. Circulation. 2006;113:2425–2434. - PubMed
- Women's Health Initiative Study Group. Design of the Women's Health Initiative clinical trial and observational study. Control Clin Trials. 1998;19:61–109. - PubMed
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