An Evaluation of Estrogenic Substances in the Treatment of Cerebral Vascular Disease

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Abstract
A cooperative clinical investigation was undertaken in 17 Veterans Administration Hospitals to determine the effects of long-term therapy with conjugated equine estrogens (Premarin) in prevention of recurrent cerebral infarction or death due to atherosclerotic vascular disease. To date, 582 men with cerebral infarction have been assigned on a random basis to either the treatment or control groups and observed for periods as long as 34 months. Initial treatment consisted of 1.25 mg. of Premarin daily and was increased to 2.5 mg. after the first year. Estrogenic therapy failed to reduce the incidence of either cerebral or myocardial infarction developing during the period of follow-up observation. There was likewise no significant change in the mortality rate following onset of therapy. Of the 63 deaths in the study, 34 occurred in patients receiving treatment and 29 among those receiving the placebo preparation. Approximately 40 per cent of patients developed mild side reactions to the estrogenic agent, usually consisting of breast tenderness or enlargement, or both. These preliminary observations failed to demonstrate that treatment with conjugated equine estrogenic hormones in small and moderate dosages for an average period of 16.7 months had any value in lowering the recurrence of cerebral infarction or reducing the mortality rate subsequent to this disorder.

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