A clinical trial of estrogen-replacement therapy after ischemic stroke.
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-17beta 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 orthe recurrence of stroke in postmenopausal women with cerebrovascular disease. This therapy should not be prescribed for the secondary prevention of cerebrovascular disease.
Viscoli
C M
CM
Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn. 06520-8056, USA.
Brass
L M
LM
Kernan
W N
WN
Sarrel
P M
PM
Suissa
S
S
Horwitz
R I
RI
D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000188:drug therapy; D004311:Double-Blind Method; D004717:Endometrium / Q000187:drug effects; D004958:Estradiol / Q000009:adverse effects / Q000627:therapeutic use*; D015914:Estrogen Replacement Therapy / Q000009:adverse effects; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000188:drug therapy; D008875:Middle Aged; D017698:Postmenopause; D055502:Secondary Prevention; D012720:Severity of Illness Index; D020521:Stroke / Q000145:classification / Q000188:drug therapy* / Q000401:mortality / Q000517:prevention & control; D016896:Treatment Outcome
D004958:Estradiol