Background
Menopausal vasomotor symptoms (ie, hot flashes and night sweats) have been associated
with unfavorable risk factors and surrogate markers of cardiovascular disease, but
their association with clinical cardiovascular disease events is unclear.
Objective
To examine the associations between different components of vasomotor symptoms, timing
of vasomotor symptoms, and risk of cardiovascular disease.
Study Design
We harmonized and pooled individual-level data from 23,365 women in 6 prospective
studies that contributed to the International Collaboration for a Life Course Approach
to Women’s Reproductive Health and Chronic Disease Events consortium. Women who experienced
cardiovascular disease events before baseline were excluded. The associations between
frequency (never, rarely, sometimes, and often), severity (never, mild, moderate,
and severe), and timing (before or after age of menopause; ie, early or late onset)
of vasomotor symptoms and incident cardiovascular disease were analyzed. Cox proportional
hazards models were used to estimate hazard ratios and 95% confidence intervals.
Results
In the adjusted model, no evidence of association was found between the frequency
of hot flashes and incident cardiovascular disease, whereas women who reported night
sweats “sometimes” (hazard ratio, 1.22; 95% confidence interval, 1.02–1.45) or “often”
(hazard ratio, 1.29; 95% confidence interval, 1.05–1.58) had higher risk for cardiovascular
disease. Increased severity of either hot flashes or night sweats was associated with
higher risk of cardiovascular disease. The hazards ratios of cardiovascular disease
in women with severe hot flashes, night sweats, and any vasomotor symptoms were 1.83
(95% confidence interval, 1.22–2.73), 1.59 (95% confidence interval, 1.07–2.37), and
2.11 (95% confidence interval, 1.62–2.76), respectively. Women who reported severity
of both hot flashes and night sweats had a higher risk for cardiovascular disease
(hazard ratio, 1.55; 95% confidence interval, 1.24–1.94) than those with hot flashes
alone (hazard ratio, 1.33; 95% confidence interval, 0.94–1.88) and night sweats alone
(hazard ratio, 1.32; 95% confidence interval, 0.84–2.07). Women with either early-onset
(hazard ratio, 1.38; 95% confidence interval, 1.10–1.75) or late-onset (hazard ratio,
1.69; 95% confidence interval, 1.32–2.16) vasomotor symptoms had an increased risk
for incident cardiovascular disease compared with women who did not experience vasomotor
symptoms.
Conclusion
Severity rather than frequency of vasomotor symptoms (hot flashes and night sweats)
was associated with increased risk of cardiovascular disease. Vasomotor symptoms with
onset before or after menopause were also associated with increased risk of cardiovascular
disease.
Key words
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Article Info
Publication History
Published online: June 22, 2020
Accepted:
June 18,
2020
Received in revised form:
May 18,
2020
Received:
January 20,
2020
Footnotes
The authors report no conflict of interest.
The International Collaboration for a Life Course Approach to Women’s Reproductive Health and Chronic Disease Events project is funded by the Australian National Health and Medical Research Council project grant (APP1027196). G.D.M. is supported by Australian National Health and Medical Research Council Principal Research Fellowship (APP1121844). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Cite this article as: Zhu D, Chung HF, Dobson AJ et al. Vasomotor menopausal symptoms and risk of cardiovascular disease: a pooled analysis of six prospective studies. Am J Obstet Gynecol 2020;223:898.e1-16.
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