title: Lower Death Risk for Vascular Dementia Than for Alzheimer's Disease With Postmenopausal Hormone Therapy Users.
abstract: There are conflicting data on postmenopausal hormone therapy (HT) and the risk of vascular dementia (VD) and Alzheimer's disease (AD).
  
  
  
  We analyzed the mortality risk attributable to VD or AD in women with a history of HT use.
  
  
  
  Finnish women (n = 489,105) using systemic HT in 1994 to 2009 were identified from the nationwide drug reimbursement register. Of these women, 581 died of VD and 1057 of AD from 1998 to 2009. Observed deaths in HT users with <5 or ≥5 years of exposure were compared with deaths that occurred in the age-standardized female population. Furthermore, we compared the VD or AD death risk of women who had started HT at <60 vs ≥60 years of age.
  
  
  
  Risk of death from VD was reduced by 37% to 39% (<5 or ≥5 years of exposure) with the use of any systemic HT, and this reduction was not associated with the duration or type (estradiol only or estradiol-progestin combination) of HT. Risk of death from AD was not reduced with systemic HT use <5 years, but was slightly reduced (15%) if HT exposure exceeded 5 years. Age at systemic HT initiation (<60 vs ≥60 years) did not affect the death risk reductions.
  
  
  
  Estradiol-based HT use is associated with a reduced risk of death from both VD and AD, but the risk reduction is larger and appears sooner in VD than AD.
authors.affiliation: Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, 00029 Helsinki, Finland.|Biomedicum, Folkhälsan Research Center, 00029 Helsinki, Finland.
authors.forename: Tomi S
authors.initials: TS
authors.lastname: Mikkola
authors.affiliation: Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, 00029 Helsinki, Finland.|Biomedicum, Folkhälsan Research Center, 00029 Helsinki, Finland.
authors.forename: Hanna
authors.initials: H
authors.lastname: Savolainen-Peltonen
authors.affiliation: Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, 00029 Helsinki, Finland.
authors.forename: Pauliina
authors.initials: P
authors.lastname: Tuomikoski
authors.affiliation: EPID Research, 02130 Espoo, Finland.
authors.forename: Fabian
authors.initials: F
authors.lastname: Hoti
authors.affiliation: EPID Research, 02130 Espoo, Finland.
authors.forename: Pia
authors.initials: P
authors.lastname: Vattulainen
authors.affiliation: National Institute for Health and Welfare, 00271 Helsinki, Finland; and.|Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institute, S-141 83 Stockholm, Sweden.
authors.forename: Mika
authors.initials: M
authors.lastname: Gissler
authors.affiliation: Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, 00029 Helsinki, Finland.
authors.forename: Olavi
authors.initials: O
authors.lastname: Ylikorkala
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000453:epidemiology / Q000401:mortality*; D015140:Dementia, Vascular / Q000453:epidemiology / Q000401:mortality*; D004359:Drug Therapy, Combination; D004958:Estradiol / Q000627:therapeutic use*; D015914:Estrogen Replacement Therapy / Q000706:statistics & numerical data*; D004967:Estrogens / Q000627:therapeutic use*; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D008875:Middle Aged; D011372:Progestins / Q000627:therapeutic use*; D065840:Protective Factors; D013997:Time Factors
chemical_list: D004967:Estrogens; D011372:Progestins; D004958:Estradiol