EXECUTIVE SUMMARY
New data suggest that, particularly for younger, midlife women, frequent hot flashes may indicate emerging vascular dysfunction that can lead to heart disease.
- Findings from the study, conducted by a team of University of Pittsburgh School of Medicine researchers, suggest that early onset of menopausal symptoms is associated with dysfunction of the endothelium.
- The scientists studied endothelial dysfunction by assessing flow-mediated dilation, a noninvasive ultrasound measure of how well the vessel dilates in response to pressure on the wall of the blood vessel. It’s the first study to test the relationship between physiologically assessed hot flashes and endothelial cell function.
New data suggest that, particularly for younger midlife women, frequent hot flashes may indicate emerging vascular dysfunction that can lead to heart disease.1
Findings suggest that early onset of menopausal symptoms is associated with dysfunction of the endothelium. Researchers studied endothelial dysfunction by assessing flow-mediated dilation, a noninvasive ultrasound measure of how well the vessel dilates in response to pressure on the wall of the blood vessel. This is the first study to test the relationship between physiologically assessed hot flashes and endothelial cell function.
Rebecca Thurston, PhD, professor of psychiatry at the University of Pittsburgh, and colleagues examined associations between menopausal symptoms and risk for cardiovascular disease complications among postmenopausal women who took part in the National Heart, Lung, and Blood Institute Women’s Ischemia Syndrome Evaluation study, designed to assess women with suspected ischemic heart disease. The authors included 254 postmenopausal women with signs and symptoms of ischemic heart disease in their analysis.
The analysis suggested that women who experience hot flashes before age 42 were more likely to exhibit lower flow-mediated dilation, suggesting adverse endothelial changes as well as higher mortality from heart disease.1
Researchers documented the effect of hot flashes on the ability of blood vessels to dilate only in the younger percentile of women in the sample. The analysis found no association in women 54-60 years of age, indicating that early occurring hot flashes may be those most relevant to heart disease risk. The associations were independent of other heart disease risk factors.
Hot flashes have been perceived as pesky symptoms that can persist for several years near the final menstrual period, affecting quality of life for many women, Thurston notes.
“However, we now know that these symptoms persist far longer and often start earlier than we previously thought,” Thurston said in a statement accompanying the analysis publication. “Our research also suggests that for some women, particularly for younger midlife women, menopausal symptoms might mark adverse changes in the blood vessels during midlife that place them at increased risk for heart disease.”
Heart Disease Risk
These findings may provide critical information to healthcare providers working to assess heart disease risk in menopausal women, according to the North American Menopause Society (NAMS). Seventy percent of women report hot flashes, with about one-third describing these episodes as frequent or severe.2 More recent data suggest hot flashes may begin earlier than previously thought, and persist for a decade or longer.3
“Hot flashes are not just a nuisance, they have been linked to cardiovascular, bone, and brain health,” JoAnn Pinkerton, MD, NAMS, executive director of NAMS, said in a statement after the study was published. “In this study, physiologically measured hot flashes appear linked to cardiovascular changes occurring early during the menopause transition.”
Heart disease is a concern for American women; it is the leading cause of death for them. An estimated 289,000 women died from heart disease in 2013, representing about one in four of every female death.4 Although awareness of the disease in women has been raised over the past decade, only about half recognize that heart disease is the leading cause of death.5
Broken down by race, heart disease is the leading cause of death for African-American and white women in the United States. Cancer and heart disease cause roughly the same number of deaths among Hispanic women each year. Heart disease is the second-leading killer among American Indian, Alaska Native, and Asian or Pacific Islander women.6
Identify Risks
The National Heart, Lung, and Blood Institute estimates that 80% of women 40-60 years of age exhibit one or more of the modifiable risk factors for heart disease: high blood pressure, high cholesterol, overweight/obesity, physical inactivity, diabetes, and smoking. Experts estimate 60% of women 20-39 years of age demonstrate one or more of these risk factors. With obesity rates climbing among younger women, public health officials warn of the risk of higher rates of heart disease in later years.
“While more work needs to be done to confirm our findings, our research could, one day, help us predict the midlife women who might be at increased risk for cardiovascular disease so that we proactively target these women for early prevention strategies,” Thurston said.
REFERENCES
- Thurston RC, Chang Y, Barinas-Mitchell E, et al. Physiologically assessed hot flashes and endothelial function among midlife women. Menopause 2017; doi: 10.1097/GME.0000000000000857. [Epub ahead of print].
- Schwingl PJ, Hulka BS, Harlow SD. Risk factors for menopausal hot flashes. Obstet Gynecol 1994;84:29-34.
- Freeman EW, Sammel MD, Grisso JA, et al. Hot flashes in the late reproductive years: Risk factors for African American and Caucasian women. J Womens Health Gend Based Med 2001;10:67-76.
- Xu JQ, Murphy SL, Kochanek KD, et al. Deaths: Final data for 2013. National vital statistics reports; 64(2). Hyattsville, MD: National Center for Health Statistics. 2016.
- Mosca L, Mochari-Greenberger H, Dolor RJ, et al. Twelve-year follow-up of American women’s awareness of cardiovascular disease risk and barriers to heart health. Circ Cardiovasc Qual Outcomes 2010;3:120-127.
- Heron M. Deaths: Leading causes for 2008. National vital statistics reports; 60(6). Hyattsville, MD: National Center for Health Statistics. 2012.
New data suggest that, particularly for younger midlife women, frequent hot flashes may indicate emerging vascular dysfunction that can lead to heart disease.
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