Menopausal vasomotor symptoms and subclinical atherosclerotic cardiovascular disease – a population-based study

Abstract

BACKGROUND Menopausal vasomotor symptoms (VMS) have been associated with subclinical and manifest atherosclerotic cardiovascular disease (ASCVD) but have not been studied in relation to image-detected coronary atherosclerosis. We assessed the association between VMS and subclinical ASCVD in peri- and postmenopausal women, considering a wide range of cardiovascular related risk factors that could potentially influence the relationship. METHODS This cross-sectional population-based study was conducted on a subset of participants from the Swedish CArdioPulmonary BioImage Study (SCAPIS), including women 50-65 years of age. The women underwent comprehensive cardiovascular assessments and completed an extensive questionnaire, which included questions about current and previous menopause-related symptoms. VMS was assessed on a 4-point scale and analyzed in relation to subclinical ASCVD, detected via coronary computed tomography angiography (CCTA), coronary artery calcium score (CACS) and carotid ultrasound using logistic regression analyses. RESULTS Of 2995 women included, 14.2% reported previous or on-going severe VMS (n=425), 18.1% moderate VMS (n=543), and 67.7% no or mild VMS (n=2027). Women who had ever experienced severe VMS, but not those with ever moderate VMS, had higher prevalence of CCTA-detected coronary atherosclerosis (34.1 vs 27.8%, p=0.017), but not segmental involvement score (SIS) >3 (4.5 vs 5.1%, p>0.05), CACS>100 (5.8 vs 6.6%, p>0.05) or any carotid plaque (47.6% vs 46.6%, p>0.05) than women with never or ever mild VMS. Using the same reference, ever severe but not moderate VMS was significantly associated with CCTA-detected coronary atherosclerosis, odds ratio (OR) after multivariable adjustment 1.33, 95% CI 1.02?1.72. This association was only present for durations of severe VMS of more than 5 years (multivariable adjusted OR 1.53 95% CI 1.09-2.14) or when the onset of severe VMS occurred before menopause (multivariable adjusted OR 1.60 95% CI 1.06-2.42). Additional adjustment for menopausal hormone therapy strengthened the associations whereas additional adjustment for physical activity did not. No significant association with SIS>3, CACS>100, nor with any carotid plaque was observed. CONCLUSIONS Previous or on-going severe but not moderate VMS were significantly associated with CCTA-detected coronary atherosclerosis, independent of a broad range of cardiovascular risk factors. No corresponding associations was observed for SIS>3, CACS>100 or carotid atherosclerosis.