Severity of vasomotor symptoms may be linked to CVD risk

By Nicole MacKee
Severity of hot flushes and night sweats are associated with an increased risk of cardiovascular disease (CVD), Australian and international researchers have reported in the American Journal of Obstetrics and Gynecology.

An adjusted analysis of six prospective studies, led by University of Queensland researchers, found that women who reported severe hot flushes, night sweats or any vasomotor symptoms (VMS) were at increased risk of developing CVD (hazard ratios [HR], 1.83, 1.59 and 2.11, respectively).

The studies included data from more than 23,000 women, with a mean age at baseline of 48 years and mean age at last follow up of 59 years. During the study period, 1947 cardiovascular events were reported.

Women with early onset VMS (before menopause; HR, 1.38) or late onset VMS (after menopause; HR, 1.69) were also found to be at increased risk of incident CVD, compared with women who did not report symptoms.

No link was found between frequency of hot flushes and CVD, although women who reported experiencing night sweats ‘sometimes’ (HR, 1.22) or ‘often’ (HR, 1.29) had a slightly elevated risk of CVD.

The researchers wrote that menopausal vasomotor symptoms had been associated with unfavourable risk factors and surrogate markers of CVD, but their association with clinical cardiovascular events had been unclear.

These findings, they said, would help clinicians to identify women who may need close monitoring in clinical practice.

Professor Martha Hickey, Professor of Obstetrics and Gynaecology at the University of Melbourne, said most women experienced hot flushes and night sweats during menopause, and these findings were not cause for alarm.

The findings did suggest, however, that more severe symptoms may be a ‘female­-specific risk factor for cardiovascular disease’.

Professor Hickey, who is also Director of the Women’s Gynaecology Research Centre at The Royal Women’s Hospital Melbourne, said the findings emphasised the importance of recognising sex differences across a range of health domains.

‘Heart disease is a major killer in women,’ she said, pointing to Go Red for Women, an international campaign to raise awareness of the importance of heart health in women (https://www.world­heart­federation.org/programmes/go-red-women).

‘It has become clearer that women have different symptoms of heart disease. They have different pathophysiology, their outcomes are different, and this study adds to the growing body of knowledge about sex differences around heart disease.’
Am J Obstet Gynecol 2020; doi: https://doi.org/10.1016/j.ajog.2020.06.039.