title: Trajectories of Vasomotor Symptoms and Carotid Intima Media Thickness in the Study of Women's Health Across the Nation.
abstract: OBJECTIVE
  Emerging work has linked menopausal vasomotor symptoms (VMS) to subclinical cardiovascular disease (CVD) among women. However, VMS are dynamic over time. No studies have considered how temporal patterns of VMS may relate to subclinical CVD. We tested how temporal patterns of VMS assessed over 13 years were related to carotid intima media thickness (IMT) among midlife women.
  
  
  METHODS
  The Study of Women's Health Across the Nation is a longitudinal cohort study of midlife women. Eight hundred and eleven white, black, Hispanic, and Chinese participants with a well-characterized final menstrual period completed measures of VMS, a blood draw, and physical measures approximately annually for 13 years. Women underwent a carotid artery ultrasound at study visit 12.
  
  
  RESULTS
  Four trajectories of VMS were identified by trajectory analysis (consistently high, early-onset, late-onset, persistently low VMS) and tested in relation to carotid indices in linear regression models. Results indicated that women with early-onset VMS had both greater mean IMT (beta, b [standard error, SE]=0.03 [0.01], P=0.03) and greater maximal IMT (b [SE]=0.04 [0.01], P=0.008) than women with consistently low VMS, adjusting for demographics and CVD risk factors.
  
  
  CONCLUSIONS
  This is the first study to test trajectories of VMS in relation to subclinical CVD. Women with VMS early in the menopause transition had higher mean IMT and maximal IMT than those with consistently low VMS across the transition. Associations were not accounted for by demographic factors nor by CVD risk factors. Results can signal to women in need of early CVD risk reduction.
authors.affiliation: From the Department of Psychiatry, University of Pittsburgh School of Medicine (R.C.T., K.A.M.), Department of Epidemiology, University of Pittsburgh Graduate School of Public Health (R.C.T., S.R.E.K., P.G.T., H.-Y.C., K.A.M.), PA; Department of Medicine, Division of Cardiovascular Medicine, University of Michigan School of Medicine, Ann Arbor (E.A.J.); and Department of Psychiatry, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA (H.J.). thurstonrc@upmc.edu.
authors.forename: Rebecca C
authors.initials: RC
authors.lastname: Thurston
authors.affiliation: From the Department of Psychiatry, University of Pittsburgh School of Medicine (R.C.T., K.A.M.), Department of Epidemiology, University of Pittsburgh Graduate School of Public Health (R.C.T., S.R.E.K., P.G.T., H.-Y.C., K.A.M.), PA; Department of Medicine, Division of Cardiovascular Medicine, University of Michigan School of Medicine, Ann Arbor (E.A.J.); and Department of Psychiatry, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA (H.J.).
authors.forename: Samar R
authors.initials: SR
authors.lastname: El Khoudary
authors.affiliation: From the Department of Psychiatry, University of Pittsburgh School of Medicine (R.C.T., K.A.M.), Department of Epidemiology, University of Pittsburgh Graduate School of Public Health (R.C.T., S.R.E.K., P.G.T., H.-Y.C., K.A.M.), PA; Department of Medicine, Division of Cardiovascular Medicine, University of Michigan School of Medicine, Ann Arbor (E.A.J.); and Department of Psychiatry, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA (H.J.).
authors.forename: Ping Guo
authors.initials: PG
authors.lastname: Tepper
authors.affiliation: From the Department of Psychiatry, University of Pittsburgh School of Medicine (R.C.T., K.A.M.), Department of Epidemiology, University of Pittsburgh Graduate School of Public Health (R.C.T., S.R.E.K., P.G.T., H.-Y.C., K.A.M.), PA; Department of Medicine, Division of Cardiovascular Medicine, University of Michigan School of Medicine, Ann Arbor (E.A.J.); and Department of Psychiatry, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA (H.J.).
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Jackson
authors.affiliation: From the Department of Psychiatry, University of Pittsburgh School of Medicine (R.C.T., K.A.M.), Department of Epidemiology, University of Pittsburgh Graduate School of Public Health (R.C.T., S.R.E.K., P.G.T., H.-Y.C., K.A.M.), PA; Department of Medicine, Division of Cardiovascular Medicine, University of Michigan School of Medicine, Ann Arbor (E.A.J.); and Department of Psychiatry, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA (H.J.).
authors.forename: Hadine
authors.initials: H
authors.lastname: Joffe
authors.affiliation: From the Department of Psychiatry, University of Pittsburgh School of Medicine (R.C.T., K.A.M.), Department of Epidemiology, University of Pittsburgh Graduate School of Public Health (R.C.T., S.R.E.K., P.G.T., H.-Y.C., K.A.M.), PA; Department of Medicine, Division of Cardiovascular Medicine, University of Michigan School of Medicine, Ann Arbor (E.A.J.); and Department of Psychiatry, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA (H.J.).
authors.forename: Hsiang-Yu
authors.initials: HY
authors.lastname: Chen
authors.affiliation: From the Department of Psychiatry, University of Pittsburgh School of Medicine (R.C.T., K.A.M.), Department of Epidemiology, University of Pittsburgh Graduate School of Public Health (R.C.T., S.R.E.K., P.G.T., H.-Y.C., K.A.M.), PA; Department of Medicine, Division of Cardiovascular Medicine, University of Michigan School of Medicine, Ann Arbor (E.A.J.); and Department of Psychiatry, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA (H.J.).
authors.forename: Karen A
authors.initials: KA
authors.lastname: Matthews
mesh_terms: D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000453:epidemiology*; D059168:Carotid Intima-Media Thickness / Q000639:trends*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008593:Menopause / Q000502:physiology; D008875:Middle Aged; D017698:Postmenopause / Q000502:physiology; D011446:Prospective Studies; D014481:United States / Q000453:epidemiology; D014666:Vasomotor System / Q000473:pathology*; D016387:Women's Health / Q000639:trends*
keywords: atherosclerosis; epidemiology; menopause; sex; women