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HORMONE REPLACEMENT THERAPY AND NEUROLOGICAL OUTCOME IN WOMEN IN CARDIAC SURGERY

^* Department of Anesthesia and Division of Cardiac Surgery, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, Ontario M5G 2C4

INTRODUCTION: Recent studies have demonstrated that women are at higher risk from neurological complications after cardiac surgery. There are conflicting results with respect to estrogen therapy reducing the risk of stroke in this patient population. Although an association between higher serum concentration of estradiol and decreased risk of cognitive decline has been established, the recent randomized trials suggest that hormone replacement therapy (HRT) increases the risk of ischemic stroke in generally healthy postmenopausal women. We sought to determine the relationship between preoperative HRT and neurological outcomes in women undergoing cardiac surgery.

METHODS: Following REB approval, we examined data collected prospectively on 2425 female patients undergoing cardiac surgery between October ‘99 and September ’03. Based on preoperative HRT status patients were categorized into two groups; postmenopausal women who received HRT were included in the HRT group and women who did not receive HRT in control group. Patients were followed for development of postoperative neurological complications including stroke, TIA’s, and seizures. Numerical and categorical data were analyzed with Chi-square test, T-test and ANOVA as appropriate. A p value of less than 0.05 was considered statistically significant. Data is expressed as mean ± SD.

RESULTS: A total of 1650 women > 50 yrs of age were assessed. 234 (14%) received HRT prior to surgery. Women who received HRT were on average 3 years younger (66 ± 7 vs. (69 ± 8.0, p<0.0001), had larger Body Surface Area (1.82 ± 0.3 vs. 1.75 ± 0.3, p=0.0091), were more likely smokers (50% vs. 41%, p=0.009) and were less likely to suffer from diabetes mellitus (21% vs. 30.0%, p=0.0035). Neurological outcome data is compared in the Table. Mortality rate was 2.9% in both groups.

Neurological sequelae HRT group (n = 234) Control group (n = 1416) P value Total 5 (2.1%) 42 (2.9%) 0.48     Stroke 2 25 0.30     Seizures 3 13 0.59     TIA’s 0 4 0.62

CONCLUSIONS: There appears to be no association between preoperative HRT therapy and neurological outcomes in postmenopausal women undergoing cardiac surgery.

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