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
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of Obstetrics & GynecologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Vasomotor symptoms and menopause: findings from the Study of Women’s Health across the Nation.Obstet Gynecol Clin North Am. 2011; 38: 489-501
- Longitudinal analysis of the association between vasomotor symptoms and race/ethnicity across the menopausal transition: study of women’s health across the nation.Am J Public Health. 2006; 96: 1226-1235
- Duration of menopausal vasomotor symptoms over the menopause transition.JAMA Intern Med. 2015; 175: 531-539
- ACOG Practice Bulletin No. 141: management of menopausal symptoms.Obstet Gynecol. 2014; 123: 202-216
- Frequency and severity of vasomotor symptoms among peri- and postmenopausal women in the United States.Climacteric. 2008; 11: 32-43
- Menopausal complaints are associated with cardiovascular risk factors.Hypertension. 2008; 51: 1492-1498
- Vasomotor symptoms and lipid profiles in women transitioning through menopause.Obstet Gynecol. 2012; 119: 753-761
- Vasomotor symptoms and insulin resistance in the study of women’s health across the nation.J Clin Endocrinol Metab. 2012; 97: 3487-3494
- Hot flashes and carotid intima media thickness among midlife women.Menopause. 2011; 18: 352-358
- Hot flashes and subclinical cardiovascular disease: findings from the Study of Women’s Health Across the Nation Heart Study.Circulation. 2008; 118: 1234-1240
- Hot flushes and night sweats are associated with coronary heart disease risk in midlife: a longitudinal study.BJOG. 2015; 122: 1560-1567
- Vasomotor symptoms and mortality: the Rancho Bernardo Study.Menopause. 2009; 16: 888-891
- Vasomotor menopausal symptoms are associated with increased risk of coronary heart disease.Menopause. 2011; 18: 146-151
- Vasomotor symptoms and cardiovascular events in postmenopausal women.Menopause. 2011; 18: 603-610
- Association of vasomotor and other menopausal symptoms with risk for cardiovascular disease: a systematic review and meta-analysis.PLoS One. 2016; 11e0157417
- Menopausal symptoms and cardiovascular disease mortality in the Women’s Ischemia Syndrome Evaluation (WISE).Menopause. 2017; 24: 126-132
- InterLACE: a new International Collaboration for a Life Course Approach to Women’s Reproductive Health and Chronic Disease Events.Maturitas. 2013; 74: 235-240
- The InterLACE study: design, data harmonization and characteristics across 20 studies on women’s health.Maturitas. 2016; 92: 176-185
- Risk factors for extended duration and timing of peak severity of hot flashes.PLoS One. 2016; 11e0155079
- Risk factors for hot flashes among women undergoing the menopausal transition: baseline results from the Midlife Women’s Health Study.Menopause. 2015; 22: 1098-1107
- Risk factors for night sweats and hot flushes in midlife: results from a prospective cohort study.Menopause. 2013; 20: 953-959
- Hot flushes and night sweats differ in associations with cardiovascular markers in healthy early postmenopausal women.Menopause. 2012; 19: 1208-1214
- Menopausal hot flashes: thermoregulatory, cardiovascular, and circulating catecholamine and LH changes.Maturitas. 1984; 6: 31-43
- Menopausal symptoms and risk factors for cardiovascular disease in postmenopause.Climacteric. 2012; 15: 157-162
- Vasomotor symptoms in women and cardiovascular risk markers: systematic review and meta-analysis.Maturitas. 2015; 81: 353-361
- Early severe vasomotor menopausal symptoms are associated with diabetes.Menopause. 2014; 21: 855-860
- Menopausal hot flashes and carotid intima media thickness among midlife women.Stroke. 2016; 47: 2910-2915
- Trajectories of vasomotor symptoms and carotid intima media thickness in the study of women’s health across the nation.Stroke. 2016; 47: 12-17
- Menopausal symptoms are associated with subclinical atherosclerosis in healthy recently postmenopausal women.Climacteric. 2012; 15: 350-357
- Menopausal hot flashes: mechanisms, endocrinology, treatment.J Steroid Biochem Mol Biol. 2014; 142: 115-120
- Estrogen and coronary heart disease in women.JAMA. 1991; 265: 1861-1867
- Is an unfavourable cardiovascular risk profile a risk factor for vasomotor menopausal symptoms? Results of a population-based cohort study.BJOG. 2015; 122: 1252-1258
- Physiology of hot flashes.Am J Hum Biol. 2001; 13: 453-464
- Hot flashes and cardiac vagal control: a link to cardiovascular risk?.Menopause. 2010; 17: 456-461
- Cardiovascular, hemodynamic, neuroendocrine, and inflammatory markers in women with and without vasomotor symptoms.Menopause. 2016; 23: 1189-1198
- Sympathetic nervous system overactivity and its role in the development of cardiovascular disease.Physiol Rev. 2010; 90: 513-557
- The role of sleep difficulties in the vasomotor menopausal symptoms and depressed mood relationships: an international pooled analysis of eight studies in the InterLACE consortium.Psychol Med. 2018; 48: 2550-2561
- Concordance between self-reported and sternal skin conductance measures of hot flushes in symptomatic perimenopausal and postmenopausal women: a systematic review.Menopause. 2011; 18: 709-722
- Can self-reported strokes be used to study stroke incidence and risk factors?: evidence from the health and retirement study.Stroke. 2009; 40: 873-879
- Validating self-reported strokes in a longitudinal UK cohort study (Whitehall II): extracting information from hospital medical records versus the Hospital Episode Statistics database.BMC Med Res Methodol. 2012; 12: 83
- Moderate agreement between self-reported stroke and hospital-recorded stroke in two cohorts of Australian women: a validation study.BMC Med Res Methodol. 2015; 15: 7
- Cardiovascular risk at age 53 years in relation to the menopause transition and use of hormone replacement therapy: a prospective British birth cohort study.BJOG. 2005; 112: 476-485
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.
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
