Onset Timing, Severity of Menopausal Symptoms Help Predict Increased CVD Risk

July 7, 2020

A pooled analysis of 6 studies indicates both timing and increased severity of vasomotor menopausal symptoms could signal increased risk of cardiovascular disease events.

New research indicates timing and severity of vasomotor menopausal symptoms, such as hot flashes and night sweats, could help identify women at increased risk of cardiovascular disease.

The study, which assessed data from a cohort of more than 20k women, found increased onset of vasomotor menopausal symptoms before menopause was linked to a 38% increase in risk while late-onset was associated with a 69% increase in risk of cardiovascular disease.

“This research helps to identify women who are at a higher risk for the development of cardiovascular events and who may need close monitoring in clinical practice,” said lead investigator Gita Mishra, PhD, deputy head of the School of Public Health and Faculty of Medicine at the University of Queensland, in a statement.

While previous research has established a link between menopausal vasomotor symptoms and risk factors for cardiovascular disease, investigators pointed out certain aspects of the associations between vasomotor symptoms and cardiovascular risk remain understudied. Specifically, investigators hoped to address which components of vasomotor menopausal symptoms increase the risk of cardiovascular disease and whether the timing of symptoms was associated with increased risk.

In order to investigate both of these issues, investigators designed their study as a pooled analysis of data from 6 studies from the International collaboration for a Life course Approach to reproductive health and Chronic disease Events (InterLACE).

While InterLACE contains data on more than 2 dozen major studies, investigators limited their analysis to studies recording data related to the timing and severity of vasomotor menopausal symptoms as well as the incidence of cardiovascular events and age when the event occurred. Of note, individual patients who experienced cardiovascular events prior to baseline or had missing data related to race/ethnicity, education, body mass index (BMI), hypertension status at baseline, smoking status, menopausal status, and menopausal hormone therapy status were also excluded from the analysis.

A total of 4 classifications were created to classify the frequency and severity of vasomotor menopausal symptoms, respectively. Frequency was classified as either never, rarely, sometimes, or often experiencing vasomotor menopausal symptoms. Severity was classified as never, mild, moderate, and severe.

In total, 23,365 women were included from the 6 studies—mean age of the group at baseline was 48.3 (2.8) years and mean age at last follow-up was 59.3 years. At baseline, 58.3% reported experiencing vasomotor menopausal symptoms, with 47.8% experiencing hot flashes and 37.8% experiencing night sweats. Investigators pointed out 59.5% of women reported early-onset and 30.9% reported late-onset of vasomotor symptoms—these groups had mean ages of 48.4 (2.3) and 52.2 (3.8) years at onset, respectively.

Overall, 1947 cardiovascular events occurred among the study population during the follow-up periods. Of these, 1726 were classified as coronary heart disease events and 373 were classified as strokes.

The analysis revealed no associations between frequency of hot flashes and incident cardiovascular disease among the 23,365-woman cohort. However, results indicated those reporting night sweats “sometimes” (HR, 1.22; 95% CI, 1.02-1.45) and “often” (HR, 1.29; 95% CI, 1.05-1.58) were at an increased risk cardiovascular disease compared to those who reported no night sweats. Investigators also highlighted women reporting mild (HR, 1.70; 95% CI, 1.31-2.20) and severe (HR, 1.83; 95% CI, 1.22-2.73) hot flashes were at an increased risk of cardiovascular disease.

When examining the timing of symptom onset, results indicated early-onset (HR, 1.38; 95% CI, 1.10-1.75) and late-onset (HR, 1.69; 95% CI, 1.32-2.16) of vasomotor menopausal symptoms were associated with an increased risk of incident cardiovascular disease compared to women who did not experience symptoms.

This study, “Vasomotor Menopausal Symptoms and Risk of Cardiovascular Disease: A pooled analysis of six prospective studies,” was published in the American Journal of Obstetrics and Gynecology.