Early menopause symptoms linked to heart risks

Hot flashes and similar symptoms that hit women during their transition into menopause may be more than an annoyance, new research from the University of Pittsburgh reports. When the symptoms begin when a woman is 42 or younger, they may warn of an increased risk of dying from cardiovascular disease.

Published Wednesday in the journal Menopause, the observational study was led by Rebecca Thurston, a professor of psychiatry at Pitt’s School of Medicine. Researchers included experts from around the country as well as from Pitt and Allegheny General Hospital. They studied links between vasomotor symptoms — night sweats, hot flashes and flushes — and risk for heart disease among 254 postmenopausal women participating in the Women’s Ischemia Syndrome Evaluation study of the National Heart, Lung, and Blood Institute.

With the groundbreaking WISE study since 1998, statistician B. Delia Johnson of the Pitt Graduate School of Public Health worked on the menopause study and pointed out it does not represent an average group of women.

“These were all women who had symptoms that led them to have angiograms by their doctors. This was not a healthy population,” she said. When analyzing the study results, as a statistician she took out other factors that might affect the outcome — such as demographic and traditional cardiovascular risk factors — to examine the link of menopausal symptoms to cardiovascular health.

All of the women had shown some signs of ischemic heart disease, in which there is an inadequate blood supply to organs, especially to heart muscles. Women who started the vasomotor symptoms early were compared with women who reported them at 42 or beyond and women who reported no menopausal symptoms. The early-onset group was found to have more dysfunction in the lining of their blood vessels and a higher rate of death from heart disease.

The dysfunction in the endothelium was measured with an ultrasound showing how well an artery in the lower arm dilated as blood flow put pressure on the wall of the blood vessel. A sample of 104 women within the study group had this test.

Other recent research led up to this study, including findings from an ongoing national study of a multiethnic group of middle-age women, the Study of Women’s Health Across the Nation, which has a site at Pitt. SWAN has reported that 80 percent of women experience menopausal symptoms at some point and that they start earlier and last much longer for many women, sometimes for more than 10 years. Hot flashes were associated with heart disease risk factors including endothelial dysfunction in earlier research as well.

Ms. Thurston, who has a Ph.D. in clinical health psychology, said she hopes that continued research to confirm the latest findings will help predict which women approaching menopause might be at an increased risk so they can be helped in taking steps to keep them from developing heart disease.

In the study, participants were all over the age of 50, all still had their ovaries, and weren’t currently taking hormone therapy. Among their other characteristics: 82 percent were non-Hispanic white, 37 percent had a body mass index of more than 30, 56 percent had coronary artery disease and 33 percent had diabetes. Of the 254 women, 93 said they never had symptoms, 40 had symptoms before age 42 and 121 said symptoms began after 42.

Both groups of women reporting symptoms were younger and more often had a history of hypertension. Women with early-onset symptoms had a higher BMI than women with later-onset symptoms.

They were followed up annually for fatal and nonfatal cardiovascular events over about six years, and up to nine years later, the National Death Index was checked for any reported deaths among participants.

Forty of the women had at least one heart-disease event, and 56 died of the disease. Of the 40 with nonfatal events, 16 eventually died of heart disease. Nonfatal events included heart attack, congestive heart failure or stroke.

Women with early-onset vasomotor symptoms had “significantly higher” rates of death from cardiovascular disease than women with later-onset symptoms, the study reports. Mortality for women with no symptoms fell between the two groups. Among all the women, their recall about early symptoms might not be precise, study authors noted as a limitation of the research. Nonfatal events were about equal among the three groups.

Women with early-onset symptoms also had a lower function of the blood vessel than the other two groups. On average, the study says, the early-onset women had constriction in the blood vessel — dilation after cuff pressure was released was extremely slow. Other demographic and cardiovascular disease risk factors couldn’t explain this dysfunction. The study said the artery test supported the findings that there should be more research in the cardiovascular health of women who have menopausal symptoms early in midlife.