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Vasomotor menopausal symptoms and risk of cardiovascular disease: a pooled analysis of six prospective studies.
Am J Obstet Gynecol. 2020 12; 223(6):898.e1-898.e16.AJ

Abstract

BACKGROUND

Menopausal vasomotor symptoms (ie, hot flashes and night sweats) have been associated with unfavorable risk factors and surrogate markers of cardiovascular disease, but their association with clinical cardiovascular disease events is unclear.

OBJECTIVE

To examine the associations between different components of vasomotor symptoms, timing of vasomotor symptoms, and risk of cardiovascular disease.

STUDY DESIGN

We harmonized and pooled individual-level data from 23,365 women in 6 prospective studies that contributed to the International Collaboration for a Life Course Approach to Women's Reproductive Health and Chronic Disease Events consortium. Women who experienced cardiovascular disease events before baseline were excluded. The associations between frequency (never, rarely, sometimes, and often), severity (never, mild, moderate, and severe), and timing (before or after age of menopause; ie, early or late onset) of vasomotor symptoms and incident cardiovascular disease were analyzed. Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals.

RESULTS

In the adjusted model, no evidence of association was found between the frequency of hot flashes and incident cardiovascular disease, whereas women who reported night sweats "sometimes" (hazard ratio, 1.22; 95% confidence interval, 1.02-1.45) or "often" (hazard ratio, 1.29; 95% confidence interval, 1.05-1.58) had higher risk for cardiovascular disease. Increased severity of either hot flashes or night sweats was associated with higher risk of cardiovascular disease. The hazards ratios of cardiovascular disease in women with severe hot flashes, night sweats, and any vasomotor symptoms were 1.83 (95% confidence interval, 1.22-2.73), 1.59 (95% confidence interval, 1.07-2.37), and 2.11 (95% confidence interval, 1.62-2.76), respectively. Women who reported severity of both hot flashes and night sweats had a higher risk for cardiovascular disease (hazard ratio, 1.55; 95% confidence interval, 1.24-1.94) than those with hot flashes alone (hazard ratio, 1.33; 95% confidence interval, 0.94-1.88) and night sweats alone (hazard ratio, 1.32; 95% confidence interval, 0.84-2.07). Women with either early-onset (hazard ratio, 1.38; 95% confidence interval, 1.10-1.75) or late-onset (hazard ratio, 1.69; 95% confidence interval, 1.32-2.16) vasomotor symptoms had an increased risk for incident cardiovascular disease compared with women who did not experience vasomotor symptoms.

CONCLUSION

Severity rather than frequency of vasomotor symptoms (hot flashes and night sweats) was associated with increased risk of cardiovascular disease. Vasomotor symptoms with onset before or after menopause were also associated with increased risk of cardiovascular disease.

Authors+Show Affiliations

School of Public Health, The University of Queensland, Brisbane, Queensland, Australia. Electronic address: dongshan.zhu@uq.net.au.School of Public Health, The University of Queensland, Brisbane, Queensland, Australia.School of Public Health, The University of Queensland, Brisbane, Queensland, Australia.School of Public Health, The University of Queensland, Brisbane, Queensland, Australia; Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia.Medical Research Council Unit for Lifelong Health and Ageing at UCL, London, United Kingdom.CLOSER, UCL Institute of Education, London, United Kingdom.Department of Epidemiology and Public Health, University College London, London, United Kingdom.Department of Social Sciences and Health Policy, Wake Forest School of Medicine, NC.Department of Public Health Sciences, University of California, Davis, CA.Department of Epidemiology Graduate School of Public Health, University of Pittsburgh, PA.Department of Medicine, University of Massachusetts Medical School, Worcester, MA.School of Public Health, The University of Queensland, Brisbane, Queensland, Australia.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32585222

Citation

Zhu, Dongshan, et al. "Vasomotor Menopausal Symptoms and Risk of Cardiovascular Disease: a Pooled Analysis of Six Prospective Studies." American Journal of Obstetrics and Gynecology, vol. 223, no. 6, 2020, pp. 898.e1-898.e16.
Zhu D, Chung HF, Dobson AJ, et al. Vasomotor menopausal symptoms and risk of cardiovascular disease: a pooled analysis of six prospective studies. Am J Obstet Gynecol. 2020;223(6):898.e1-898.e16.
Zhu, D., Chung, H. F., Dobson, A. J., Pandeya, N., Anderson, D. J., Kuh, D., Hardy, R., Brunner, E. J., Avis, N. E., Gold, E. B., El Khoudary, S. R., Crawford, S. L., & Mishra, G. D. (2020). Vasomotor menopausal symptoms and risk of cardiovascular disease: a pooled analysis of six prospective studies. American Journal of Obstetrics and Gynecology, 223(6), e1-e16. https://doi.org/10.1016/j.ajog.2020.06.039
Zhu D, et al. Vasomotor Menopausal Symptoms and Risk of Cardiovascular Disease: a Pooled Analysis of Six Prospective Studies. Am J Obstet Gynecol. 2020;223(6):898.e1-898.e16. PubMed PMID: 32585222.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Vasomotor menopausal symptoms and risk of cardiovascular disease: a pooled analysis of six prospective studies. AU - Zhu,Dongshan, AU - Chung,Hsin-Fang, AU - Dobson,Annette J, AU - Pandeya,Nirmala, AU - Anderson,Debra J, AU - Kuh,Diana, AU - Hardy,Rebecca, AU - Brunner,Eric J, AU - Avis,Nancy E, AU - Gold,Ellen B, AU - El Khoudary,Samar R, AU - Crawford,Sybil L, AU - Mishra,Gita D, Y1 - 2020/06/23/ PY - 2020/01/20/received PY - 2020/05/18/revised PY - 2020/06/18/accepted PY - 2020/6/26/pubmed PY - 2021/1/5/medline PY - 2020/6/26/entrez KW - cardiovascular disease KW - hot flashes KW - night sweats KW - pooled analysis KW - vasomotor menopausal symptoms SP - 898.e1 EP - 898.e16 JF - American journal of obstetrics and gynecology JO - Am J Obstet Gynecol VL - 223 IS - 6 N2 - BACKGROUND: Menopausal vasomotor symptoms (ie, hot flashes and night sweats) have been associated with unfavorable risk factors and surrogate markers of cardiovascular disease, but their association with clinical cardiovascular disease events is unclear. OBJECTIVE: To examine the associations between different components of vasomotor symptoms, timing of vasomotor symptoms, and risk of cardiovascular disease. STUDY DESIGN: We harmonized and pooled individual-level data from 23,365 women in 6 prospective studies that contributed to the International Collaboration for a Life Course Approach to Women's Reproductive Health and Chronic Disease Events consortium. Women who experienced cardiovascular disease events before baseline were excluded. The associations between frequency (never, rarely, sometimes, and often), severity (never, mild, moderate, and severe), and timing (before or after age of menopause; ie, early or late onset) of vasomotor symptoms and incident cardiovascular disease were analyzed. Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals. RESULTS: In the adjusted model, no evidence of association was found between the frequency of hot flashes and incident cardiovascular disease, whereas women who reported night sweats "sometimes" (hazard ratio, 1.22; 95% confidence interval, 1.02-1.45) or "often" (hazard ratio, 1.29; 95% confidence interval, 1.05-1.58) had higher risk for cardiovascular disease. Increased severity of either hot flashes or night sweats was associated with higher risk of cardiovascular disease. The hazards ratios of cardiovascular disease in women with severe hot flashes, night sweats, and any vasomotor symptoms were 1.83 (95% confidence interval, 1.22-2.73), 1.59 (95% confidence interval, 1.07-2.37), and 2.11 (95% confidence interval, 1.62-2.76), respectively. Women who reported severity of both hot flashes and night sweats had a higher risk for cardiovascular disease (hazard ratio, 1.55; 95% confidence interval, 1.24-1.94) than those with hot flashes alone (hazard ratio, 1.33; 95% confidence interval, 0.94-1.88) and night sweats alone (hazard ratio, 1.32; 95% confidence interval, 0.84-2.07). Women with either early-onset (hazard ratio, 1.38; 95% confidence interval, 1.10-1.75) or late-onset (hazard ratio, 1.69; 95% confidence interval, 1.32-2.16) vasomotor symptoms had an increased risk for incident cardiovascular disease compared with women who did not experience vasomotor symptoms. CONCLUSION: Severity rather than frequency of vasomotor symptoms (hot flashes and night sweats) was associated with increased risk of cardiovascular disease. Vasomotor symptoms with onset before or after menopause were also associated with increased risk of cardiovascular disease. SN - 1097-6868 UR - https://www.unboundmedicine.com/medline/citation/32585222/Vasomotor_menopausal_symptoms_and_risk_of_cardiovascular_disease:_a_pooled_analysis_of_six_prospective_studies_ DB - PRIME DP - Unbound Medicine ER -