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November 6, 2002

Hormone Therapy and Risk of Alzheimer Disease: A Critical Time

Author Affiliations

Author Affiliations: Laboratory of Personality and Cognition, National Institute on Aging, Baltimore, Md (Dr Resnick), and Departments of Geriatrics, Neurology, Pharmacology & Toxicology, and Epidemiology, University of Arkansas for Medical Sciences, Little Rock (Dr Henderson).

JAMA. 2002;288(17):2170-2172. doi:10.1001/jama.288.17.2170

Interest in the effects of hormone therapy on health outcomes among postmenopausal women has perhaps never been greater. As recently reported,1 the Women's Health Initiative (WHI) randomized clinical trial of postmenopausal hormone therapy terminated the combined estrogen-progestin arm (but not the estrogen-only arm) early after an average follow-up of 5.2 years (planned duration, 8.5 years).2 Women who received estrogen plus progestin experienced a small but significant increase in the primary outcome, coronary heart disease; a nonsignificant trend toward an increase in the primary adverse outcome, invasive breast cancer; and a significant increase in a global index (which included the 2 primary outcomes plus stroke, pulmonary embolism, endometrial cancer, colorectal cancer, hip fracture, and death due to other causes) summarizing risk and benefit. However, the decision to stop this portion of the trial did not take into account several other important outcomes that may affect a woman's choice of whether to take hormone therapy, including potential effects on cognition. Two ancillary studies to the WHI randomized trial focus on risk of dementia and cognitive decline, but these outcomes are not considered in the WHI risk-benefit profile.