Early onset of hot flashes may signal heart disease risk
Early onset of hot flashes (sudden feelings of warmth) in the course of menopause is associated with a poorer endothelial function in women in a new study, a finding investigators say could signal emerging vascular heart disease.
“We used to think that hot flashes were just annoying symptoms that many women just tried to endure,” said lead author Dr Rebecca Thurston from the Department of Psychiatry, University of Pittsburgh School of Medicine in Pittsburgh, Philadelphia, US. “Our data now suggest that hot flashes might indicate adverse changes in the blood vessels of some women during midlife which might not be medically benign over time.”
Thurston and her team sought to examine the relationship between physiologically assessed hot flashes and endothelial function in 272 nonsmoking women (age 40 to 69 years) who were either late perimenopausal (2 to 12 months amenorrhoea) or postmenopausal (≥12 months amenorrhoea). [Menopause 2017;doi;10.1097/GME.0000000000000857]
On average, the women were about 54 years of age and had a relatively favourable cardiovascular (CV) risk factor profile. Endothelial function was assessed using brachial artery flow-mediated dilation (FMD); ambulatory hot flashes were monitored.
Excluded from the analysis were women with cardiovascular disease, neoplasia, hysterectomy or bilateral oophorectomy, kidney failure, seizures, Parkinson’s disease, Raynaud’s phenomenon, or current pregnancy.
Among the younger tertile of women (age 40-53 years), the presence of hot flashes (p = 0.01), was associated with lower flow-mediated dilation (FMD), indicating poorer endothelial function. Greater frequency of physiologic hot flashes was also associated with poorer FMD in the younger women (p = 0.03, multivariable).The associations occurred independent of other CV risk factors and estradiol levels. Of note, the associations were absent in the older women (age 54-60 years).
“Impairment in endothelial function is an initiating event in the atherosclerotic process,” said. “Among early midlife women in this study, frequent hot flashes may mark emerging vascular dysfunction.”
Hot flashes are the hallmark symptom of the menopause transition. In fact, up to 70 percent of women experience hot flashes and night sweats during menopause, said Thurston. The current data suggest that early-onset hot flashes may be a red flag that can help pinpoint women who are at increased CV risk and who may need rigorous assessment for early prevention.
“Physiologically assessed hot flashes and endothelial function among midlife women may offer valuable information for healthcare providers working to assess the risk of heart disease in their menopausal patients,” Thurston concluded.