Women early in the menopause transition who reported experiencing at least six hot flashes per 2 weeks were 62% more likely to experience a cardiovascular event during 20 years of follow-up when compared with similar women who reported no hot flashes, according to an analysis of the Study of Women’s Health Across the Nation presented at the North American Menopause Society annual meeting.
“Prior work — including our own — has linked hot flashes to CV risk factors, such as obesity, blood pressure and diabetes, or proxy measures of CVD, such as subclinical measures that image the vasculature among those without frank CVD,” Rebecca Thurston, PhD, professor of psychiatry, psychology and epidemiology at the University of Pittsburgh, told Endocrine Today. “Very little prior work has linked hot flashes to clinical CVD — that is, hard events such as heart attacks and strokes.”
Thurston and colleagues analyzed data from 3,272 premenopausal or early menopausal women aged 42 to 52 years with a uterus and at least one ovary, participating in the Study of Women’s Health Across the Nation (SWAN), a longitudinal, 20-year study of the menopause transition (47% white; 28% black). Researchers assessed vasomotor symptoms annually via questionnaire and CV events (myocardial infarction, stroke, heart failure, percutaneous coronary intervention or bypass surgery) via interview and medical records. Researchers used Cox proportional hazard models to estimate the relationship between vasomotor symptoms and combined CV events, adjusted for age, race, education, menopause status, BMI, lipids, insulin resistance and medication use (women using hormone therapy were excluded).
Within the cohort, 231 women experienced a CV event during follow-up.
Women early in the menopause transition who reported experiencing at least six hot flashes per 2 weeks were 62% more likely to experience a cardiovascular event during 20 years of follow-up when compared with similar women who reported no hot flashes.
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Researchers found that frequent baseline vasomotor symptoms were associated with a higher risk for later CV events, with an HR of 1.05 for one to five hot flashes during a 2-week period (95% CI, 0.75-1.47), and an HR of 1.62 for at least six hot flashes during 2 weeks (95% CI, 1.1-2.38), when compared with no hot flashes. More visits with frequent vasomotor symptoms over time were also associated with higher risk for later CV events (HR = 2.01; 95% CI, 1.3-3.11) when compared with no hot flashes.
“Women with frequent hot flashes in early midlife or hot flashes experienced persistently over the course of the menopause transition have increased risk for CVD events later in life,” Thurston said. “These associations were not explained by CVD risk factors.”
Thurston said the findings suggest vasomotor symptoms may provide a clue for which women may be at increased CV risk.
“For women, these results are important because we are not as good as predicting which women at midlife will go on to have clinical CVD later in life,” Thurston said. “Frequent hot flashes provide an additional clue. We don’t know if treating the hot flashes will prevent CVD. What we think is that women with a lot of hot flashes or persistent hot flashes over the menopause transition should stop smoking if they smoke, eat well, exercise, get their regular, recommended checkups, and take medications as prescribed. Now is the time for women to prioritize their health.” – by Regina Schaffer
Thurston RC, et al. Abstract S-1. Presented at: North American Menopause Society Annual Meeting; Sept. 25-28, 2019; Chicago.
Disclosure: Thurston reports no relevant financial disclosures.