MedicalResearch.com Interview with:
Tomi Mikkola MD
Helsinki University Hospital
Department of Obstetrics and Gynecology
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: In Finland we have perhaps the most comprehensive and reliable medical registers in the world. Thus, with my research group I have conducted various large studies evaluating association of postmenopausal hormone therapy use and various major diseases (see e.g. the references in the B;MJ paper). There has been various smaller studies indicating that hormone therapy might be protective for all kinds of dementias, also Alzheimer’s disease.
However, we have quite recently shown that hormone therapy seems to lower the mortality risk of vascular dementia but not Alzheimer’s disease (Mikkola TS et al. J Clin Endocrinol Metab 2017;102:870-7). Now in this upcoming BMJ-paper we report in a very large case-control study (83 688 women with Alzheimer’s disease and same number of control women without the disease) that systemic hormone therapy was associated with a 9-17% increased risk of Alzheimer’s disease.
Furthermore, this risk increase is particularly in women using hormone therapy long, for more than 10 years. This was somewhat surprising finding, but it underlines the fact that mechanisms behind Alzheimer’s disease are likely quite different than in vascular dementia, where the risk factors are similar as in cardiovascular disease. We have also shown how hormone therapy protects against cardiovascular disease, particularly in women who initiate hormone therapy soon after menopause.
MedicalResearch.com: What should readers take away from your report?
Response: The take home message is that in absolute terms, nine to 18 excess diagnoses of Alzheimer’s disease per year will be detected in 10 000 women aged 70-80 (incidence 105 per 10 000 women years in this age group), especially in those women who had used hormone therapy for over 10 years. Even though this absolute risk increase for Alzheimer’s disease is small, it emphasizes that fact that hormone therapy should be used in recently menopausal women for symptom relief, and they benefit from the therapy. However, hormone therapy should not be initiated for Alzheimer’s disease prevention and in elderly women that have used hormone for more than 10 years, should be aware that the treatment could increase their risk for Alzheimer’s disease in later life.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Our data support further research on the mechanisms behind the different dementias and also mechanistic steroid hormone action on these diseases. Furthermore, in future research the different forms of dementias, e.g. vascular dementia and Alzheimer’s disease, should be separated since the mechanisms and also hormone therapy effects could vary. We also need more research with different forms of hormone therapies, oral vs. transdermal therapy as well as different types of progestogens accompanying estrogen treatment.
Use of postmenopausal hormone therapy and risk for Alzheimer’s disease in Finland: nationwide case-control study
BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l1050
(Published 07 March 2019)Cite this as: BMJ 2019;364:l1050
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