title: Physiologically assessed hot flashes and endothelial function among midlife women.
abstract: OBJECTIVE
  Hot flashes are experienced by most midlife women. Emerging data indicate that they may be associated with endothelial dysfunction. No studies have tested whether hot flashes are associated with endothelial function using physiologic measures of hot flashes. We tested whether physiologically assessed hot flashes were associated with poorer endothelial function. We also considered whether age modified associations.
  
  
  METHODS
  Two hundred seventy-two nonsmoking women reporting either daily hot flashes or no hot flashes, aged 40 to 60 years, and free of clinical cardiovascular disease, underwent ambulatory physiologic hot flash and diary hot flash monitoring; a blood draw; and ultrasound measurement of brachial artery flow-mediated dilation to assess endothelial function. Associations between hot flashes and flow-mediated dilation were tested in linear regression models controlling for lumen diameter, demographics, cardiovascular disease risk factors, and estradiol.
  
  
  RESULTS
  In multivariable models incorporating cardiovascular disease risk factors, significant interactions by age (P < 0.05) indicated that among the younger tertile of women in the sample (age 40-53 years), the presence of hot flashes (beta [standard error] = -2.07 [0.79], P = 0.01), and more frequent physiologic hot flashes (for each hot flash: beta [standard error] = -0.10 [0.05], P = 0.03, multivariable) were associated with lower flow-mediated dilation. Associations were not accounted for by estradiol. Associations were not observed among the older women (age 54-60 years) or for self-reported hot flash frequency, severity, or bother. Among the younger women, hot flashes explained more variance in flow-mediated dilation than standard cardiovascular disease risk factors or estradiol.
  
  
  CONCLUSIONS
  Among younger midlife women, frequent hot flashes were associated with poorer endothelial function and may provide information about women's vascular status beyond cardiovascular disease risk factors and estradiol.
authors.affiliation: 1Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 2Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA 3Department of Neurosurgery 4Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 5Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland.
authors.forename: Rebecca C
authors.initials: RC
authors.lastname: Thurston
authors.forename: Yuefang
authors.initials: Y
authors.lastname: Chang
authors.forename: Emma
authors.initials: E
authors.lastname: Barinas-Mitchell
authors.forename: J Richard
authors.initials: JR
authors.lastname: Jennings
authors.forename: Roland
authors.initials: R
authors.lastname: von Känel
authors.forename: Doug P
authors.initials: DP
authors.lastname: Landsittel
authors.forename: Karen A
authors.initials: KA
authors.lastname: Matthews
mesh_terms: D000328:Adult; D000367:Age Factors; D001783:Blood Flow Velocity; D002318:Cardiovascular Diseases / Q000503:physiopathology; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology*; D004730:Endothelium, Vascular / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D019584:Hot Flashes / Q000503:physiopathology*; D006801:Humans; D008593:Menopause; D008875:Middle Aged; D018670:Monitoring, Ambulatory; D012307:Risk Factors