Estrogenic Therapy in Men With Ischemic Cerebrovascular Disease: Effect on Recurrent Cerebral Infarction and Survival

Abstract

A cooperative clinical investigation was undertaken in 15 Veterans Administration Hospitals to determine whether long-term therapy with conjugated equine estrogens prevented recurrent cerebral infarction or death due to atherosclerotic vascular disease. Follow-up observations were made for periods up to five years in 572 men with cerebral infarction who were assigned on a random basis to placebo or to treatment with 1.25 to 2.5 mg of Premarin daily. Estrogen administration failed to reduce the incidence of cerebral infarction, transient cerebral ischemia or death due to vascular disease. Although use of hormones was associated with an overall higher death rate, this excess mortality was due largely to cancer and various other diseases and could not be attributed directly to the medication. Occurrences of and deaths from myocardial infarction were less in treated than control patients, but vascular disorders, such as pulmonary embolism, mesenteric thrombosis and heart failure were more frequent in the former group. This study failed to demonstrate any beneficial effect in men with cerebral infarction from estrogens given in moderate amounts for as long as five years. There was, on the other hand, no evidence to support current reports that prolonged estrogen use in these dosages produced an increased mortality from thromboembolism.