Vasomotor symptoms and coronary artery calcium in postmenopausal women

Abstract

Objective-We assessed whether vasomotor symptoms (VMS) were associated with coronary artery calcium (CAC) and how hormone therapy may influence this association.Address for Correspondence: Matthew A. Allison, MD, MPH, 9500 Gilman Drive, Mailcode 0965, La Jolla, CA 92093-0965, 858-822-7671 (W)/858-822-7662 (F), mallison@ucsd.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Methods-Subjects were a subset of women aged 50 to 59 and a history of hysterectomy that enrolled in the Women's Health Initiative (WHI) clinical trial of estrogen alone and underwent a computed tomography scan of the chest at the end of the trial to determine CAC. Participants provided information about VMS (hot flashes and/or night sweats), as well as HT use, on selfadministered questionnaires at trial baseline. CONFLICT OF INTEREST DISCLOSURESResults-The sample consisted of 918 women with a mean (SD) age of 55.1 (2.8) years at WHI randomization and 64.8 (2.9) years at CAC ascertainment. The prevalence of a CAC score > 0 was 46%, while the prevalence of a CAC score ≥ 10 and > 100 was 39 and 19%, respectively. At randomization, 77% reported a history of any VMS at any time prior to or at enrollment in the WHI while 20% reported any VMS only present at enrollment. Compared to those without a history of any VMS and after adjustment for potential confounders, a history of any VMS at any time up to and including WHI enrollment was associated with a significantly reduced odds for CAC > 0 (Odds Ratio 0.66, 95% CI 0.45 -0.98). Moreover, as duration of HT increased the inverse association between any VMS and CAC moved toward the null.Conclusion-A history of any VMS was significantly associated with a reduced odds for CAC independent of traditional CVD risk factors and other relevant covariates. This association appears to be influenced by duration of hormone therapy.

Hot flushes and night sweats are associated with coronary heart disease risk in midlife: a longitudinal study

“…14 Furthermore, for IMT and CAC the opposite findings have also been reported, 3,11 and the Rancho Bernardo Study reported a reduced rate of mortality caused by cardiovascular disease (CVD) in women reporting night sweats, but not hot flushes. 15 To our knowledge, only two previous studies have investigated the associations between VMS and incident CVD, and their findings are contradictory.…”

“…Both the opposite findings and null findings have also been reported, however. 3,[11][12][13][14] The main limitation of most previous studies is their cross-sectional design, which makes it difficult to draw firm conclusions regarding causal pathways. Until now, only three prospective studies have examined the associations of hot flushes and night sweats with CHD incidence or mortality.…”

“…Several studies have found that women with VMS have less favourable cardiovascular markers than those reporting no symptoms. [5][6][7][8] Other studies have reported reduced endothelial function, 3,9 increased intima media thickness (IMT), 10 and coronary artery calcifications (CAC), 11 among women with hot flushes. In another study, however, hot flushes were not significantly associated with blood pressure, 12 endothelial function, 13 or lipids and inflammatory markers.…”

Vasomotor symptoms in women and cardiovascular risk markers: Systematic review and meta-analysis

“…All studies reporting on the association of hot flushes, night sweats or combined (presence, history, duration or severity) and CAC were consistent in showing no association [14,31,36,37]. One study showed no cross-sectional association between severity of hot flashes or night sweats and IMT [37].…”

“…After the initial screening based on titles and abstracts, 103 articles in full text were extracted for further evaluation. In the full-text assessment, 16 of these articles and 11 unique studies [12][13][14][15][31][32][33][34][35][36][37] met our inclusion criteria and were included in the current systematic review and meta-analysis. Of the 87 articles excluded following full text evaluation, 60 were based on unrelated exposures, 14 did not report relevant risk estimates and 13 were duplicate publications.…”