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Previous Volume 345:1243-1249 October 25, 2001 Number 17 Next

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ABSTRACT

Background Observational studies have suggested that estrogen-replacement therapy may reduce a woman's risk of stroke and death.

Methods We conducted a randomized, double-blind, placebo-controlled trial of estrogen therapy (1 mg of estradiol-17 per day) in 664 postmenopausal women (mean age, 71 years) who had recently had an ischemic stroke or transient ischemic attack. Women were recruited from 21 hospitals in the United States and were followed for the occurrence of stroke or death.

Results During a mean follow-up period of 2.8 years, there were 99 strokes or deaths among the women in the estradiol group, and 93 among those in the placebo group (relative risk in the estradiol group, 1.1; 95 percent confidence interval, 0.8 to 1.4). Estrogen therapy did not reduce the risk of death alone (relative risk, 1.2; 95 percent confidence interval, 0.8 to 1.8) or the risk of nonfatal stroke (relative risk, 1.0; 95 percent confidence interval, 0.7 to 1.4). The women who were randomly assigned to receive estrogen therapy had a higher risk of fatal stroke (relative risk, 2.9; 95 percent confidence interval, 0.9 to 9.0), and their nonfatal strokes were associated with slightly worse neurologic and functional deficits.

Conclusions Estradiol does not reduce mortality or the recurrence of stroke in postmenopausal women with cerebrovascular disease. This therapy should not be prescribed for the secondary prevention of cerebrovascular disease.

Source Information

From the Departments of Internal Medicine (C.M.V., W.N.K., R.I.H.), Neurology (L.M.B., P.M.S.), Epidemiology and Public Health (L.M.B., P.M.S., R.I.H.), and Gynecology and Obstetrics (P.M.S.), Yale University School of Medicine, New Haven, Conn.; the Veterans Affairs Connecticut Healthcare System, West Haven, Conn. (L.M.B.); and the Department of Epidemiology and Biostatistics and the Department of Medicine, McGill University, Montreal (S.S.).

Address reprint requests to Dr. Viscoli at the Department of Medicine, 333 Cedar St., Rm. 1072 LMP, P.O. Box 208056, Yale University School of Medicine, New Haven, CT 06520-8056.

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