When the news release launches with a discussion of two huge studies and saying that the “largest study comprised approximately 230,000 Finnish women and the follow-up time in different studies was up to 20 years” you think you are going to hear some stunning findings with ample evidence to back them up. Instead, this release about the possible benefits of hormone therapy as a way to prevent Alzheimer’s is very light on actual information. It provides some cautionary notes in a few spots, but it also obscures some key facts from the same studies it touts.
It’s true that Alzheimer’s disease disproportionately affects more women than men and research into why is an important public health question. But as presented, even with caveats, this release might encourage women to embark on long-term hormone therapy with no evidence showing it prevents Alzheimer’s disease. On the other hand, many large studies have shown that hormone therapy does carry many serious health risks.
There is no discussion of costs in the release. Hormone replacement therapies have been on the market for decades, and their well-known costs should have been included. The cost to an individual may not be very high, but the cost to society of unnecessary, and potentially harmful, hormone prescriptions could be very high.
The release provides no numbers to back up the claims about the benefits of hormone replacement therapy. It references two studies, a case control study (one that starts with an outcome and then then traces back to investigate what the patient was exposed to) of 230,000 women and a prospective cohort study (one that follows people over time to determine how specific factors affect rates of a specific outcome) of about 8,195 women, both of which find very small decreases in Alzheimer’s disease only in those women who had been taking estrogens for more than 10 years. The decrease is barely significant in both case and could be due to unrelated variables that are not discussed in the release.
The large case control study published in Maturitas concludes: “Our findings do not suggest HT is an important determinant of AD risk.”
The prospective cohort study published in Neurology concludes: “Our results do not provide strong evidence for a protective association between postmenopausal HT use and AD or dementia, although we observed a reduced AD risk among those with long-term self-reported HT use.”
The release makes no mention of the harms associated with hormone replacement therapy. These are well documented in multiple studies and include a heightened risk of breast cancer and other types of cancer.
The release sets out to describe two main studies and to provide some caveats. But by putting the emphasis on the number of people who were included in the studies and not providing any actual data around benefits or harms it skews the view being presented. It suggests to readers that the massive size of the studies must be proof enough that the benefits of hormone replacement therapy are clear.
In trying to place these findings in context, the release says, “In in vitro and animal studies, estrogen has showed neuroprotective effects. However, studies on humans have yielded inconsistent results on the association between postmenopausal estrogen-based hormone replacement therapy and dementia risk.”
This starts to take the release in the right direction, but without any additional information to back up the statements about the benefits of hormone replacement therapy, the reader is left with the impression that taking hormone replacement therapy as early as possible in menopause will protect a woman from dementia. Instead, the release should have explained that the large number of women being studied only included a small number of women who developed Alzheimer’s. In one study, out of 8,195 women, there were only 227 cases of Alzheimer’s. Those real numbers and real context should have been provided.
There is no disease mongering in the release. The release also provides some context concerning how Alzheimer’s disproportionately affects women.
The release does not mention any of the funding sources for the studies. It would be preferable if all funding sources were cited, but we don’t penalize releases or stories unless they fail to report industry funding and commercial ties. These reports were funded by government and academic research institutions, and foundations.
The release does not discuss any alternatives. Numerous other other observational studies, many stronger than this one, are exploring possible Alzheimer’s risk reduction strategies involving diet, exercise and “brain games.” But according to the National Institute on Aging, “So far, studies have not demonstrated that, over the long term, health or lifestyle factors can prevent or slow Alzheimer’s disease or age-related cognitive decline. Similarly, clinical trial results do not support the use of any particular medication or dietary supplement to prevent these conditions.”
The release presumes that people know that hormone replacement therapies are available. In this particular case, there has been so much negative news around hormone replacement therapies because of their linkage to cancer risks that it would have been worth noting that the therapies are available by prescription.
We’ll give the release a pass here because it cites several avenues of past research and doesn’t make a direct claim of novelty.
The release makes it seem that the sheer size of the studies mentioned here make the findings novel, but it does not prove that these findings are novel.
The release doesn’t rely on sensational language. With the exception of the headline (“Postmenopausal hormone therapy exceeding ten years may protect from dementia”) and some vague claims, the language in the release is essentially in line with the findings of the studies being discussed. The release does say that the results were weak, which is also what the studies said.