Menopausal Complaints Are Associated With Cardiovascular Risk Factors

Abstract

Abstract-It has been hypothesized that women with vasomotor symptoms differ from those without with respect to cardiovascular risk factors or responses to exogenous hormone therapy. We studied whether the presence and extent of menopausal complaints are associated with cardiovascular risk profile. Data were used from a population-based sample of 5523 women, aged 46 to 57 years, enrolled between 1994 and 1995. Data on menopausal complaints and potential confounders were collected by questionnaires. Total cholesterol, systolic and diastolic blood pressures, and body mass index were measured. Linear and logistic regression analyses were used to analyze the data. Night sweats were reported by 38% and flushing by 39% of women. After multivariate adjustment, women with complaints of flushing had a 0.27-mmol/L (95% CI: 0.15 to 0.39) higher cholesterol level, a 0.60-kg/m 2 (95% CI: 0.35 to 0.84) higher BMI, a 1.59-mm Hg (95% CI: 0.52 to 2.67) higher systolic blood pressure, and a 1.09-mm Hg (95% CI: 0.48 to 1.69) higher diastolic blood pressure compared with asymptomatic women. Flushing was also associated with hypercholesterolemia (odds ratio: 1.52; 95% CI: 1.25 to 1.84) and hypertension (OR: 1.20; 95% CI: 1.07 to 1.34). Results were similar for complaints of night sweating. The findings support the view that menopausal complaints are associated with a less favorable cardiovascular risk profile. These findings substantiate the view that differences in the presence of menopausal symptoms as a reason for using hormone therapy could explain discrepant findings between observational research and trials. A number of observational studies demonstrated a protective association between hormone therapy (HT) and cardiovascular disease (CVD). 1-3 Placebo-controlled, randomized trials, however, could not confirm a cardioprotective effect and showed no overall benefit of HT on the risk of cardiovascular events. 4,5 Many potential reasons have been proposed to explain this apparent discrepancy between the observational studies and the trials. An important difference is that, in the observational studies, the most common reason to initiate HT was to relieve menopausal complaints. In contrast, in the trials, women with severe complaints were either excluded or composed only a minority of the total randomized population. Results of a recent subgroup analysis of the combined Women's Health Initiative trials showed that women who initiated HT closer to menopause had a reduced coronary heart disease (CHD) risk compared with the increase in CHD risk among women initiating HT more distant from menopause. 6 Moreover, among women 50 to 59 years old at enrollment in the Women's Health Initiative, end-of-trial coronary calcium scores were lower in women assigned to estrogens than in those assigned to placebo. 7 A younger age is likely to be accompanied by a higher frequency of menopausal complaints.We hypothesized previously that women with vasomotor symptoms may differ from those without with respect to cardiovascular risk factors or responses...

Hot Flash Frequency and Blood Pressure: Data from the Study of Women's Health Across the Nation

“…These associations were in part, but not fully accounted for, by confounders such as BMI. 22 Prior studies suggest an association between VMS and cardiovascular risk parameters that may also influence BP. Thurston and colleagues, using data from SWAN Heart, observed that women who reported having any hot flashes over a 2-week period were more likely to have reduced flowmediated dilation, a marker of subclinical CVD.…”

Current Approach to Menopause

“…However, recent studies have shown that obese women report more vasomotor symptoms than thinner women. Increased body fat rate may cause these symptoms by increasing body temperature (10,11). There was also a relationship between vasomotor symptoms and high BMI and waist circumference.…”

“…Thus, obesity can be considered as a common factor for metabolic syndrome and vasomotor symptoms. Postmenopausal women with vasomotor symptoms generally have a worse lipid profile than women without symptoms (10,12,13). Menopause, the end of fertility, is experienced by each individual with different characteristics.…”

Cardiovascular Risk During the Menopause

“…Changes in the lipid profile, obesity, hypertension, glucose intolerance and diabetes mellitus may become relevant as risk factors of cardiovascular disease [2]. Vascular disease represents the most frequent cause of mortality and morbidity in the woman, more than cancer either in the United States as in Europe [3].…”