Increased Frequency of Menopause Symptoms Could Signal Increased Risk of CV Events

This article was originally published on PracticalCardiology.com.

Could frequency or incidence of menopause symptoms help clinicians predict risk of cardiovascular disease events?

Using data from the Study of Women’s Health Across the Nation (SWAN) study, results of a new study suggest women with frequent vasomotor menopausal symptoms (VMS) were at a 52% greater risk of experiencing a cardiovascular event.

“This study is the largest, longitudinal study to date to address the relationships between midlife VMS and risk of subsequent incident cardiovascular disease events. We found that frequent VMS at baseline as well as frequent VMS that persisted over time were associated with elevated risk of a combined outcome of incident fatal and nonfatal cardiovascular disease events,” wrote investigators.

Despite recent advances in care, cardiovascular disease remains among the leading causes of death in women. With recent studies indicating experiencing VMS could impact cardiovascular health, investigators designed the current study to evaluate the relationship between VMS and cardiovascular disease events.

Launched in 1996, SWAN was designed as a longitudinal cohort study to examine the menopause transition. The study enrolled 3302 women between the ages of 42 and 52 years who were followed for up to 22 years and attended up to 16 follow-up visits.

As part of SWAN, VMS were assessed through questionnaires at baseline and each follow-up visit. For the purpose of the analysis, VMS frequency was defined as no VMS, VMS 1-5 days per 2 weeks, and VMS 6 or more days per 2 weeks. Using SWAN, investigators also obtained data related to physical measurements, phlebotomy, and reported cardiovascular disease events.

Of note, 219 women from the 3302-woman cohort were excluded from the current study. These women were excluded due to missing data on cardiovascular disease events, missing data on VMS, or missing follow-up data. Cardiovascular events of interest for the current study included myocardial infarction, cerebrovascular accident/stroke, heart failure, or revascularization procedures.

In Cox proportional hazards models adjusted for demographics, medication use, and other risk factors, results indicated experiencing VMS 6 or more days in a 2-week period was associated with a 51% increase in risk of cardiovascular disease events compared to women not experiencing VMS (HR, 1.51; 95% CI, 1.05-2.17; P=.03). Further analysis indicated women reporting frequent VMS that persisted over time, which investigators defined as more than 33% of study visits, were at a 77% greater risk of a cardiovascular event than those who reported VMS at 33% or fewer studies (HR, 1.77; 95% CI, 1.33-2.35; P <.0001).

“We found that frequent VMS or persistent VMS over midlife are associated with a 50% to 77% increased risk of future cardiovascular disease events. Thus, VMS may represent a novel, female‐specific cardiovascular disease risk factor, as VMS may point to women at risk of future cardiovascular disease events beyond those identified on the basis of traditional cardiovascular disease risk factors,” added investigators.

This study, “Menopausal Vasomotor Symptoms and Risk of Incident Cardiovascular Disease Events in SWAN,” was published in the Journal of the American Heart Association.