To: Andrew H who wrote (16485 ) 3/5/1998 1:32:00 PM From: Henry Niman Read Replies (2) | Respond to of 32384
Speaking of understanding, LGND will soon be targeting Alzheimer's with designer estrogens (and rexinoids?). This came out yesterday (John Groome, LGND board member, was CEO of Athena): Wednesday March 4, 4:03 pm Eastern Time Company Press Release Estrogen Therapy for Prevention and Treatment of Alzheimer's -- Studies Look Good But Still Too Soon to Tell SAN FRANCISCO--(BW HealthWire)--March 4, 1998--In the United States alone, about 30 million women are treated with estrogen replacement therapy (ERT) for symptoms of menopause, a number which has grown exponentially over the past ten years. While it is widely believed that ERT also helps prevent heart disease and osteoporosis, its efficacy in preventing dementia and improving cognition in postmenopausal women is frequently suggested but less clear. Hoping to settle this hotly debated question, researchers at the San Francisco Veterans Affairs Medical Center and the University of California San Francisco reviewed every published estrogen study and reached some conclusions. Their findings are published in today's issue (March 4) of The Journal of the American Medical Association. ''It appears there is an association between estrogen replacement therapy and prevention of dementia but whether thus is due to estrogen use per se, or to other factors associated with ERT remains to be seen,'' said Kristine Yaffe, MD, head of the department of geriatric psychiatry at the SFVAMC and UCSF assistant professor of psychiatry. ''Translation: it might help but it might not.'' Possible reasons for the apparent positive effect of ERT on preventing dementias include a patient's age, education, socio-economic background, overall health, and medication compliance. Yaffe points out that the typical characteristics of patients who opt for ERT are the same variables associated with a low incidence of Alzheimer's and other dementias. The team first reviewed the literature and then analyzed the ten studies which addressed the association between postmenopausal ERT and the risk of Alzheimer's disease or other dementias. Since several studies indicated a clear benefit while a few suggested no effect or an actual increase of dementia associated with estrogen use, the researchers performed a meta-analysis. A meta-analysis is a statistical method of combining the results of smaller previous studies to illustrate their outcomes better. Results of the meta-analysis suggest that ERT reduces the risk of developing Alzheimer's disease and other dementias by almost 30 percent. According to Yaffe, the study's lead author, a meta-analysis helps to put the studies' original results in perspective but it cannot fix some of their individual shortcomings. ''What we've done is summarize all of the available data in a way that lets us see the big picture,'' said Yaffe. The researchers conclude that large, placebo-controlled trials are required to determine accurately the role of ERT in prevention and treatment of Alzheimer's disease and other dementias. Several such trials are underway but meaningful results will not be available for several years. Without those findings, Yaffe says it is premature to use ERT for prevention of Alzheimer's disease and other dementias, or for treating these dementias. So how does a postmenopausal woman decide if ERT is appropriate for her? ''Like every medical treatment, this is a highly individualized decision,'' said Yaffe. ''Women should discuss estrogen therapy with their primary care doctor and weigh all the pros and cons. There are many important factors that must be taken into account such as a patient's medical history and her family history of heart disease, osteoporosis or breast cancer.'' Estrogen is a naturally occurring sex hormone, primary produced in the ovaries, which regulates certain reproductive functions in women. Women's bodies stop producing estrogen at menopause, which typically occurs around age 50. When the production of estrogen initially ceases, many women experience symptoms which can be quite severe, such as hot flashes with accompanying insomnia and night sweats, nausea and heart palpitations. It is commonly held that decreased estrogen levels in postmenopausal women are associated with an increased risk of heart disease and osteoporosis. Hence, many women take ERT for their symptoms of menopause as well as to prevent the two diseases. If estrogen does prove to help prevent dementia, it would be of major public health importance. Approximately ten percent of people over the age of 65 and nearly half of those more than 85 years old have dementia. Alzheimer's disease, the most common cause of dementia, is estimated to affect 3.75 million Americans at a cost of $67 billion annually. Co-investigators on the study included George Sawaya, MD, UCSF assistant professor of obstetrics & gynecology; Ivan Lieberburg, MD, PhD, UCSF clinical professor of medicine and vice president of research at Athena Neurosciences; and Deborah Grady, MD, MPH, UCSF associate professor of medicine and epidemiology. Contact: University of California, San Francisco James Larkin, 415/750-6633