Trajectories of Vasomotor Symptoms and Carotid Intima Media Thickness in the Study of Women’s Health Across the Nation

Thurston, Rebecca C.; Khoudary, Samar R. El; Tepper, Ping G.; Jackson, Elizabeth A.; Joffe, Hadine; Chen, Hsiang‐Yu; Matthews, Karen A.; Appendix,; Harlow, Sioḃán D.; Sowers, MaryFran; Finkelstein, Joel S.; Neer, Robert M.; Kravitz, Howard M.; Powell, Lynda H.; Gold, Ellen B.; Greendale, Gail A.; Derby, Carol A.; Wildman, Rachel P.; Santoro, Nanette; Weiss, Gerson; Rossi, Winifred K.; Sherman, Sherry; Ory, Marcia G.; McConnell, Daniel S.; Brooks, Maria M.; Sutton-Tyrrell, Kim; McKinlay, Sonja M.; Johnson, Stewart W.; Gallagher, Chris

doi:10.1161/strokeaha.115.010600

Cited by 66 publications

(38 citation statements)

References 31 publications

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“…In the Penn Ovarian Aging Study over 30% of women reported having VMS at study entry, in their late reproductive years when they were still cycling regularly. 3 In the Study of Women’s Health Across the Nation (SWAN), VMS trajectories constructed from VMS assessed prospectively over 13 years of the menopause transition were examined in relation to subclinical CVD, 17 finding similar to the present results, that it was women with early onset VMS who had the highest subclinical CVD. Conversely, in the WHI observational study, it was the women with later onset VMS (reported at entry) who showed the highest risk.…”

Section: Discussionsupporting

confidence: 71%

“…The few studies examining clinical CVD events yield mixed and inconclusive findings. 14-16 Further, emerging data indicate that associations between VMS and CVD risk may depend on the age at which VMS occur, 15,17 yet an age-dependence of VMS-CVD risk associations is not routinely examined. Thus, there is an important gap in knowledge about age-dependent relationships between VMS and adverse CVD events.…”

Section: Introductionmentioning

confidence: 99%

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Menopausal symptoms and cardiovascular disease mortality in the Women's Ischemia Syndrome Evaluation (WISE)

et al. 2017

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Objective Studies have linked vasomotor symptoms to markers of cardiovascular disease risk, yet few have considered clinical cardiovascular events. Data suggest that associations may depend upon the age that symptoms occur. We examined associations between vasomotor symptoms and cardiovascular events and endothelial function, considering age of symptom onset. Methods The Women’s Ischemia Syndrome Evaluation enrolled women referred for coronary angiography for suspected myocardial ischemia. 254 women aged >50 years, postmenopausal, with both ovaries, not taking hormone therapy underwent a baseline evaluation, were followed annually (median=6.0 years), and the National Death Index was searched to ascertain cardiovascular disease mortality (median=9.3 years). A subset of participants underwent brachial artery ultrasound for flow mediated dilation. Receiver operating curve analysis was used to determine vasomotor symptom groups [symptoms beginning

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Section: Discussionsupporting

confidence: 71%

Section: Introductionmentioning

confidence: 99%

Menopausal symptoms and cardiovascular disease mortality in the Women's Ischemia Syndrome Evaluation (WISE)

et al. 2017

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“…39 In other studies, the pattern of VMS has been shown to be associated with the risk of cardiovascular events in post-menopausal women. 40 VMS patterns may be related to a variety of relevant clinical outcomes.…”

Section: Discussionmentioning

confidence: 89%

Characterizing the trajectories of vasomotor symptoms across the menopausal transition

et al. 2016

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Objective To investigate the heterogeneity of temporal patterns of vasomotor symptoms (VMS) over the menopausal transition and to identify factors associated with these patterns in a diverse sample of women. Methods The Study of Women's Health Across the Nation is a multi-site longitudinal study of women from five racial/ethnic groups transitioning through the menopause. The analytic sample included 1455 women with non-surgical menopause and a median follow-up of 15.4 years. Temporal patterns of VMS and associations with serum estradiol and follicle stimulation hormone, race/ethnicity, body mass index (BMI), and demographic and psychosocial factors were examined using group-based trajectory modeling. Results Four distinct trajectories of VMS were found: onset early (11 years prior to the final menstrual period (FMP)) with decline after menopause (Early onset, 18.4%); onset near the FMP with later decline (Late onset, 29.0%), onset early with persistently high frequency (High, 25.6%); and persistently low frequency (Low, 27.0%). Relative to women with persistently Low frequency of VMS, women with persistently High and Early onset VMS had a more adverse psychosocial and health profile. Black women were overrepresented in the Late onset and High VMS subgroups relative to white women. Obese women were underrepresented in the Late onset subgroup. In multivariable models, the pattern of estradiol over the menopause was significantly associated with the VMS trajectory. Conclusions These data demonstrate distinctly heterogeneous patterns of menopausal symptoms which are associated with race/ethnicity, reproductive hormones, pre-menopause BMI and psychosocial characteristics. Early targeted intervention may have a meaningful impact on long-term VMS.

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“…The timing of hot flashes can vary dramatically across women, with some indication that early-occurring hot flashes may be those most relevant to CVD risk. 14, 21 Similar to relations between a range of female reproductive factors (e.g., hormone therapy, hot flashes) and markers of CVD risk in women, 21, 22 any modifying role of chronologic or ovarian aging in these associations requires careful consideration.…”

Section: Introductionmentioning

confidence: 99%

Physiologically assessed hot flashes and endothelial function among midlife women

Thurston

Chang²,

Barinas‐Mitchell

et al. 2017

Menopause

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Objective Hot flashes are experienced by most midlife women. Emerging data indicate that they may be associated with endothelial dysfunction. No studies have tested whether hot flashes are associated with endothelial function using physiologic measures of hot flashes. We tested whether physiologically-assessed hot flashes were associated with poorer endothelial function. We also considered whether age modified associations. Methods 272 nonsmoking women reporting either daily hot flashes or no hot flashes, aged 40-60, and free of clinical cardiovascular disease underwent ambulatory physiologic hot flash and diary hot flash monitoring; a blood draw; and ultrasound measurement of brachial artery flow mediated dilation to assess endothelial function. Associations between hot flashes and flow mediated dilation were tested in linear regression models controlling for lumen diameter, demographics, cardiovascular disease risk factors, and estradiol. Results In multivariable models incorporating cardiovascular disease risk factors, significant interactions by age (p<.05) indicated that among the younger tertile of women in the sample (ages 40-53), the presence of hot flashes [beta(standard error)=-2.07 (.79), p=.01], and more frequent physiologic hot flashes were associated with lower flow mediated dilation [for each hot flash: beta(standard error)=-.10(.05), p=.03, multivariable]. Associations were not accounted for by estradiol. Associations were not observed among the older women (ages 54-60) or for prospective-reported hot flash frequency, severity, or bother. Among the younger women, hot flashes explained more variance in flow mediated dilation than standard cardiovascular disease risk factors or estradiol. Conclusions Among younger midlife women, frequent hot flashes were associated with poorer endothelial function and may provide information about women's vascular status beyond cardiovascular disease risk factors and estradiol.

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Trajectories of Vasomotor Symptoms and Carotid Intima Media Thickness in the Study of Women’s Health Across the Nation

Cited by 66 publications

References 31 publications

Menopausal symptoms and cardiovascular disease mortality in the Women's Ischemia Syndrome Evaluation (WISE)

Menopausal symptoms and cardiovascular disease mortality in the Women's Ischemia Syndrome Evaluation (WISE)

Characterizing the trajectories of vasomotor symptoms across the menopausal transition

Physiologically assessed hot flashes and endothelial function among midlife women

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