Menopausal Hot Flashes and Carotid Intima Media Thickness Among Midlife Women.
There has been a longstanding interest in the role of menopause and its correlates in the development of cardiovascular disease (CVD) in women. Menopausal hot flashes are experienced by most midlife women; emerging data link hot flashes to CVD risk indicators. We tested whether hot flashes, measured via state-of-the-art physiologic methods, were associated with greater subclinical atherosclerosis as assessed by carotid ultrasound. We considered the role of CVD risk factors and estradiol concentrations in these associations.



A total of 295 nonsmoking women free of clinical CVD underwent ambulatory physiologic hot flash assessments; a blood draw; and carotid ultrasound measurement of intima media thickness and plaque. Associations between hot flashes and subclinical atherosclerosis were tested in regression models controlling for CVD risk factors and estradiol.



More frequent physiologic hot flashes were associated with higher carotid intima media thickness (for each additional hot flash: β [SE]=0.004 [0.001]; P=0.0001; reported hot flash: β [SE]=0.008 [0.002]; P=0.002, multivariable) and plaque (eg, for each additional hot flash, odds ratio [95% confidence interval] plaque index ≥2=1.07 [1.003-1.14]; P=0.04, relative to no plaque, multivariable] among women reporting daily hot flashes; associations were not accounted for by CVD risk factors or by estradiol. Among women reporting hot flashes, hot flashes accounted for more variance in intima media thickness than most CVD risk factors.



Among women reporting daily hot flashes, frequent hot flashes may provide information about a woman's vascular status beyond standard CVD risk factors and estradiol. Frequent hot flashes may mark a vulnerable vascular phenotype among midlife women.
From the Department of Psychiatry (R.C.T., J.R.J., K.A.M.), Department of Neurosurgery (Y.C.), and Department of Medicine (D.P.L.), University of Pittsburgh School of Medicine, PA; Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, PA (R.C.T., E.B.-M., K.A.M.); Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Denver (N.S.); and Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland (R.v.K.). thurstonrc@upmc.edu.
Rebecca C
RC
Thurston
From the Department of Psychiatry (R.C.T., J.R.J., K.A.M.), Department of Neurosurgery (Y.C.), and Department of Medicine (D.P.L.), University of Pittsburgh School of Medicine, PA; Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, PA (R.C.T., E.B.-M., K.A.M.); Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Denver (N.S.); and Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland (R.v.K.).
Yuefang
Y
Chang
From the Department of Psychiatry (R.C.T., J.R.J., K.A.M.), Department of Neurosurgery (Y.C.), and Department of Medicine (D.P.L.), University of Pittsburgh School of Medicine, PA; Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, PA (R.C.T., E.B.-M., K.A.M.); Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Denver (N.S.); and Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland (R.v.K.).
Emma
E
Barinas-Mitchell
From the Department of Psychiatry (R.C.T., J.R.J., K.A.M.), Department of Neurosurgery (Y.C.), and Department of Medicine (D.P.L.), University of Pittsburgh School of Medicine, PA; Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, PA (R.C.T., E.B.-M., K.A.M.); Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Denver (N.S.); and Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland (R.v.K.).
J Richard
JR
Jennings
From the Department of Psychiatry (R.C.T., J.R.J., K.A.M.), Department of Neurosurgery (Y.C.), and Department of Medicine (D.P.L.), University of Pittsburgh School of Medicine, PA; Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, PA (R.C.T., E.B.-M., K.A.M.); Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Denver (N.S.); and Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland (R.v.K.).
Doug P
DP
Landsittel
From the Department of Psychiatry (R.C.T., J.R.J., K.A.M.), Department of Neurosurgery (Y.C.), and Department of Medicine (D.P.L.), University of Pittsburgh School of Medicine, PA; Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, PA (R.C.T., E.B.-M., K.A.M.); Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Denver (N.S.); and Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland (R.v.K.).
Nanette
N
Santoro
From the Department of Psychiatry (R.C.T., J.R.J., K.A.M.), Department of Neurosurgery (Y.C.), and Department of Medicine (D.P.L.), University of Pittsburgh School of Medicine, PA; Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, PA (R.C.T., E.B.-M., K.A.M.); Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Denver (N.S.); and Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland (R.v.K.).
Roland
R
von Känel
From the Department of Psychiatry (R.C.T., J.R.J., K.A.M.), Department of Neurosurgery (Y.C.), and Department of Medicine (D.P.L.), University of Pittsburgh School of Medicine, PA; Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, PA (R.C.T., E.B.-M., K.A.M.); Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Denver (N.S.); and Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland (R.v.K.).
Karen A
KA
Matthews
D050197:Atherosclerosis / Q000000981:diagnostic imaging*; D002318:Cardiovascular Diseases / Q000175:diagnosis*; D059168:Carotid Intima-Media Thickness; D005260:Female; D019584:Hot Flashes / Q000503:physiopathology*; D006801:Humans; D008875:Middle Aged; D047648:Perimenopause / Q000502:physiology*; D017698:Postmenopause / Q000502:physiology*; D012307:Risk Factors
atherosclerosis; cardiovascular diseases; hot flashes; intima media thickness; menopause; vasomotor symptoms; women