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Randomized Controlled Trial
. 2014 Feb 4;82(5):427-34.
doi: 10.1212/WNL.0000000000000079. Epub 2014 Jan 2.

Change in brain and lesion volumes after CEE therapies: the WHIMS-MRI studies

Laura H Coker  1 , Mark A Espeland, Patricia E Hogan, Susan M Resnick, R Nick Bryan, Jennifer G Robinson, Joseph S Goveas, Christos Davatzikos, Lewis H Kuller, Jeff D Williamson, Cheryl D Bushnell, Sally A Shumaker; WHIMS-MRI Study Group
Affiliations
Randomized Controlled Trial

Change in brain and lesion volumes after CEE therapies: the WHIMS-MRI studies

Laura H Coker et al. Neurology. .

Abstract

Objectives: To determine whether smaller brain volumes in older women who had completed Women's Health Initiative (WHI)-assigned conjugated equine estrogen-based hormone therapy (HT), reported by WHI Memory Study (WHIMS)-MRI, correspond to a continuing increased rate of atrophy an average of 6.1 to 7.7 years later in WHIMS-MRI2.

Methods: A total of 1,230 WHI participants were contacted: 797 (64.8%) consented, and 729 (59%) were rescanned an average of 4.7 years after the initial MRI scan. Mean annual rates of change in total brain volume, the primary outcome, and rates of change in ischemic lesion volumes, the secondary outcome, were compared between treatment groups using mixed-effect models with adjustment for trial, clinical site, age, intracranial volumes, and time between MRI measures.

Results: Total brain volume decreased an average of 3.22 cm(3)/y in the active arm and 3.07 cm(3)/y in the placebo arm (p = 0.53). Total ischemic lesion volumes increased in both arms at a rate of 0.12 cm(3)/y (p = 0.88).

Conclusions: Conjugated equine estrogen-based postmenopausal HT, previously assigned at WHI baseline, did not affect rates of decline in brain volumes or increases in brain lesion volumes during the 4.7 years between the initial and follow-up WHIMS-MRI studies. Smaller frontal lobe volumes were observed as persistent group differences among women assigned to active HT compared with placebo. Women with a history of cardiovascular disease treated with active HT, compared with placebo, had higher rates of accumulation in white matter lesion volume and total brain lesion volume. Further study may elucidate mechanisms that explain these findings.

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Figures

Figure 1
Figure 1. WHIMS-MRI2 CONSORT diagram
CEE = conjugated equine estrogen; CONSORT = Consolidated Standards of Reporting Trials; HT = hormone therapy; MPA = medroxyprogesterone acetate; WHIMS = Women's Health Initiative Memory Study.
Figure 2
Figure 2. WHIMS-MRI2 adjusted mean brain volumes with 95% CI by treatment arm
CI = confidence interval; WHIMS = Women's Health Initiative Memory Study.
See this image and copyright information in PMC

Comment in

References

    1. Wnuk A, Korol DL, Erickson KI. Estrogens, hormone therapy, and hippocampal volume in postmenopausal women. Maturitas 2012;73:186–190 - PMC - PubMed
    1. Resnick SR, Espeland MA, Jaramillo SA, et al. Postmenopausal hormone therapy and regional brain volumes: the WHIMS-MRI Study. Neurology 2009;72:135–142 - PMC - PubMed
    1. Anderson GL, Manson J, Wallace R, et al. Implementation of the Women's Health Initiative study design. Ann Epidemiol 2003;13:S5–S17 - PubMed
    1. Jaramillo SA, Felton D, Andrews LA, et al. Enrollment in a brain magnetic resonance study: results from the Women's Health Initiative Memory Study Magnetic Resonance Imaging Study (WHIMS-MRI). Acad Radiol 2007;14:603–612 - PMC - PubMed
    1. Coker LH, Hogan PE, Bryan NR, et al. Postmenopausal hormone therapy and subclinical cerebrovascular disease: the WHIMS-MRI Study. Neurology 2009;72:125–134 - PMC - PubMed

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