Number, severity of menopausal symptoms may up CV risk

Women who experience two or more moderate or severe menopausal symptoms may have an elevated risk of cardiovascular disease (CVD) or strokes, according to a study presented at NAMS 2020.

The results were from a secondary analysis of 20,050 women aged 50–79 years enrolled in the Women’s Health Initiative (WHI)-Calcium and Vitamin D trial. The randomized trial assessed the impact of daily calcium (1,000 mg) and vitamin D (400 IU of 25-hydroxyvitamin-D) on multiple health outcomes (hip fracture, colorectal cancer, invasive breast cancer, all-cause mortality, coronary heart disease, stroke, cardiovascular death, and total CVD). The women were followed up for a median 7 years. 

A questionnaire was used to assess severity of menopausal symptoms at baseline. These symptoms included vasomotor symptoms (hot flashes and night sweats), heart racing or skipping beats, tremors, restlessness, fatigue, difficulty concentrating, forgetfulness, dizziness, mood swings, vaginal dryness, breast tenderness, headache or migraine, and waking up multiple times at night.

Women with ≥2 moderate or severe menopausal symptoms had an increased risk of total CVD (hazard ratio [HR], 1.37, 95 percent confidence interval [CI], 1.20–1.56) compared with those without menopausal symptoms. This risk was not observed in women who experienced just one moderate or severe menopausal symptom (HR, 1.00, 95 percent CI, 0.87–1.15; p_trend<0.001). [NAMS 2020, abstract S-18]

Experiencing moderate or severe menopausal symptoms was also associated with an increased risk of stroke, with a higher risk observed with ≥2 symptoms (HR, 1.41, 95 percent CI, 1.04–1.91) than one symptom (HR, 1.19, 95 percent CI, 0.88–1.61; p_trend=0.02) compared with no symptoms.

Conversely, severity of vasomotor symptoms did not appear to be associated with any of the health outcomes examined in this study.

None of the associations appeared to be mitigated by calcium and vitamin D supplementation.

“We found that even severe hot flashes were not associated with any adverse clinical health outcomes when occurring on their own, but if they or any other moderate to severe menopause symptoms were present in combination, there was an association with an increased risk of CVD,” said study lead author Dr Matthew Nudy from Penn State Hershey Medical Center,  Hershey, Pennsylvania, US.

“[The results suggest that] the number or type of moderate or severe menopausal symptoms, but not vasomotor symptoms alone, may be a marker for a higher risk of CVD,” highlighted Nudy and co-authors.

“With heart disease remaining the number one killer of women, studies like this are invaluable,” added Dr Stephanie Faubion, medical director of The North American Menopause Society (NAMS), who was not affiliated with the study.

“Healthcare providers need to be aware that menopause symptoms may be more than a benign nuisance, and women suffering from these symptoms may be at increased risk for CVD. Identifying women at high risk is important so that risk reduction strategies can be implemented,” she noted.