Abstract Details

Title Higher Lifetime Exposure to Gonadal Hormones is Associated With Lower White Matter Hyperintensities Burden: A UK Biobank Study in Post-Menopausal Women

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P6 - Poster Session 6 (5:30 PM-6:30 PM)

Poster/Presentation
Number 6-006

Objective The aim of this study was to examine the relationship between lifetime exposure to endogenous and exogenous gonadal hormones on white matter hyperintensities (WMH) in post-menopausal women.

Background The onset of menopause accelerates the development of brain biomarkers of small vessel disease, such as WMH, supporting the cerebrovascular-protective effects of hormones. However, whether this effect is influenced by lifetime exposure to hormones is unclear.

Design/Methods Two measures of lifetime endogenous hormone exposure (ENHE) were explored: 1) cumulative number of years with a natural menstrual cycle and 2) cumulative number of live childbirths in women having never received hormone replacement therapy (HRT, n=6039). For exogenous hormone exposure (EXHE): 1) the use of oral HRT and 2) topical HRT (n=246). WMH volume was obtained from preprocessed T2-FLAIR images.

Results In a linear model adjusted for intracranial volume, age, oral contraceptive use, socio-demographics, and cardiovascular risk factors, both ENHEcycle and EMNHEparity were negatively associated with WMH (R2 = 0.30, F = 241, DF = 6027, p<0.0001; βparity = -0.025, p = 0.006; βcycle = -0.003 p = 0.017). For EXHE, women who received topical HRT had significantly lower WMH volume than oral HRT (t=1.99, p= 0.048) after correcting for intracranial volume, age, socio-demographics, cardiovascular risk factors, ENHEcycle and ENHEparity.

Conclusions Our results provide further evidence that lifetime exposure to endogenous hormones appears to have an independent protective effect on WMH burden, and extending this with exogenous topical HRT may confer additional protection. The stronger effect of parity may be due to prolonged exposure to elevated estrogen resulting in long-lasting structural or functional changes in the small cerebral vessels.

Authors/Disclosures
Thomas-Louis Perron, MD PRESENTER	Dr. Perron has nothing to disclose.
	No disclosure on file
	No disclosure on file
Christian Bocti, MD	Dr. Bocti has nothing to disclose.
	No disclosure on file

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