Use of menopausal hormone therapy and risk of dementia: nested case-control studies using QResearch and CPRD databases
Use of menopausal hormone therapy and risk of dementia: nested case-control studies using QResearch and CPRD databases
OBJECTIVE: To assess the risks of developing dementia associated with different types and durations of menopausal hormone therapy.
DESIGN: Two nested case-control studies.
SETTING: UK general practices contributing to QResearch or the Clinical Practice Research Datalink (CPRD), using all links to hospital, mortality, and social deprivation data.
PARTICIPANTS: 118 501 women aged 55 and older with a primary diagnosis of dementia between 1998 and 2020, matched by age, general practice, and index date to 497 416 female controls.
MAIN OUTCOME MEASURES: Dementia diagnoses from general practice, mortality, and hospital records; odds ratios for menopausal hormone treatments adjusted for demographics, smoking status, alcohol consumption, comorbidities, family history, and other prescribed drugs.
RESULTS: Overall, 16 291 (14%) women with a diagnosis of dementia and 68 726 (14%) controls had used menopausal hormone therapy more than three years before the index date. Overall, no increased risks of developing dementia associated with menopausal hormone therapy were observed. A decreased global risk of dementia was found among cases and controls younger than 80 years who had been taking oestrogen-only therapy for 10 years or more (adjusted odds ratio 0.85, 95% confidence interval 0.76 to 0.94). Increased risks of developing specifically Alzheimer's disease were found among women who had used oestrogen-progestogen therapy for between five and nine years (1.11, 1.04 to 1.20) and for 10 years or more (1.19, 1.06 to 1.33). This was equivalent to, respectively, five and seven extra cases per 10 000 woman years. Detailed risk associations for the specific progestogens studied are also provided.
CONCLUSION: This study gives estimates for risks of developing dementia and Alzheimer's disease in women exposed to different types of menopausal hormone therapy for different durations and has shown no increased risks of developing dementia overall. It has shown a slightly increased risk of developing Alzheimer's disease among long term users of oestrogen-progestogen therapies.
Aged, Aged, 80 and over, Alzheimer Disease/chemically induced, Case-Control Studies, Databases, Factual, Dementia/chemically induced, Estrogen Replacement Therapy/adverse effects, Estrogens/adverse effects, Female, Humans, Middle Aged, Odds Ratio, Postmenopause/drug effects, Progestins/adverse effects, Risk Factors, United Kingdom/epidemiology
Vinogradova, Yana
c416958c-c260-421c-a5fc-6bedc1a4e567
Dening, Tom
9a76d578-8130-4559-928a-752bbc2db082
Hippisley-Cox, Julia
ffe3b07c-6ca2-4487-b69b-6ea2b039ab13
Taylor, Lauren
5d3587d6-8468-492a-8c74-be50dc87a525
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Coupland, Carol
5d123e7a-f406-4d6b-a09d-2e019de3686f
30 September 2021
Vinogradova, Yana
c416958c-c260-421c-a5fc-6bedc1a4e567
Dening, Tom
9a76d578-8130-4559-928a-752bbc2db082
Hippisley-Cox, Julia
ffe3b07c-6ca2-4487-b69b-6ea2b039ab13
Taylor, Lauren
5d3587d6-8468-492a-8c74-be50dc87a525
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Coupland, Carol
5d123e7a-f406-4d6b-a09d-2e019de3686f
Vinogradova, Yana, Dening, Tom, Hippisley-Cox, Julia, Taylor, Lauren, Moore, Michael and Coupland, Carol
(2021)
Use of menopausal hormone therapy and risk of dementia: nested case-control studies using QResearch and CPRD databases.
BMJ (Clinical research ed.), 374, [n2182].
(doi:10.1136/bmj.n2182).
Abstract
OBJECTIVE: To assess the risks of developing dementia associated with different types and durations of menopausal hormone therapy.
DESIGN: Two nested case-control studies.
SETTING: UK general practices contributing to QResearch or the Clinical Practice Research Datalink (CPRD), using all links to hospital, mortality, and social deprivation data.
PARTICIPANTS: 118 501 women aged 55 and older with a primary diagnosis of dementia between 1998 and 2020, matched by age, general practice, and index date to 497 416 female controls.
MAIN OUTCOME MEASURES: Dementia diagnoses from general practice, mortality, and hospital records; odds ratios for menopausal hormone treatments adjusted for demographics, smoking status, alcohol consumption, comorbidities, family history, and other prescribed drugs.
RESULTS: Overall, 16 291 (14%) women with a diagnosis of dementia and 68 726 (14%) controls had used menopausal hormone therapy more than three years before the index date. Overall, no increased risks of developing dementia associated with menopausal hormone therapy were observed. A decreased global risk of dementia was found among cases and controls younger than 80 years who had been taking oestrogen-only therapy for 10 years or more (adjusted odds ratio 0.85, 95% confidence interval 0.76 to 0.94). Increased risks of developing specifically Alzheimer's disease were found among women who had used oestrogen-progestogen therapy for between five and nine years (1.11, 1.04 to 1.20) and for 10 years or more (1.19, 1.06 to 1.33). This was equivalent to, respectively, five and seven extra cases per 10 000 woman years. Detailed risk associations for the specific progestogens studied are also provided.
CONCLUSION: This study gives estimates for risks of developing dementia and Alzheimer's disease in women exposed to different types of menopausal hormone therapy for different durations and has shown no increased risks of developing dementia overall. It has shown a slightly increased risk of developing Alzheimer's disease among long term users of oestrogen-progestogen therapies.
Text
bmj.n2182.full
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More information
Accepted/In Press date: 26 August 2021
Published date: 30 September 2021
Keywords:
Aged, Aged, 80 and over, Alzheimer Disease/chemically induced, Case-Control Studies, Databases, Factual, Dementia/chemically induced, Estrogen Replacement Therapy/adverse effects, Estrogens/adverse effects, Female, Humans, Middle Aged, Odds Ratio, Postmenopause/drug effects, Progestins/adverse effects, Risk Factors, United Kingdom/epidemiology
Identifiers
Local EPrints ID: 483326
URI: http://eprints.soton.ac.uk/id/eprint/483326
ISSN: 0959-8138
PURE UUID: 4a8eb38b-8ca1-4259-8675-9f5065a80b93
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Date deposited: 29 Oct 2023 18:48
Last modified: 17 Mar 2024 03:01
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Contributors
Author:
Yana Vinogradova
Author:
Tom Dening
Author:
Julia Hippisley-Cox
Author:
Lauren Taylor
Author:
Carol Coupland
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