Neal S. Parikh, MD

Thurston RC, El Khoudary SR, Tepper PG, Jackson EA, Joffe H, Chen HY, and Matthews KA. Trajectories of Vasomotor Symptoms and Carotid Intima Media Thickness in the Study of Women’s Health Across the Nation. Stroke. 2016

Thurston and colleagues sought to assess the relationship between trajectories of menopause-related vasomotor symptoms (VMS) (such as hot flashes and night sweats) and carotid intima media thickness (IMT).
The authors note that the patterns of VMS vary substantially among women; symptoms can occur prior to menopause, during or for long periods after. Temporal variations and differences in patterns are hypothesized to have different physiologic underpinnings and sequela, including for cardiovascular disease. 

The Study of Women’s Health Across the Nation (SWAN) – a multiethnic, longitudinal cohort of peri-menopausal women between the ages of 42-52 not using oral contraceptive or hormone therapy, served as the study cohort. The cohort enrollment assessments occurred in 1996-1997. After up to 13 annual visits, women underwent carotid ultrasound imaging.

811 of 1512 women with IMT data were ultimately included. They were required to have had at least 3 visits during which they completed questionnaires regarding VMS and to be notably free of a history of stroke or myocardial infarction. IMT was measured at the common carotid artery. The mean and maximal IMT were used for analyses. Covariates were site, age, ethnicity, education, BMI, blood pressure, lipid profile, diabetes, smoking status, use of cardiovascular medications and anxiety.

A statistical approach termed “group based growth trajectory modeling” was used to identify four distinct trends: consistently low VMS burden, consistently high VMS burden, early-onset (self-limited) VMS and late-onset VMS. At baseline, high VMS burden and early onset VMS were associated with cardiovascular disease risk factors.

Unadjusted, consistently high VMS burden was associated with increased IMT. Of the four trajectories, early onset VMS (onset up to 10 years prior to final menstrual period and subsiding over several years) was associated with increased mean and maximal IMT in linear regression adjusted for demographics and cardiovascular disease risk factors.

It seems, then, that early-onset VMS is independently associated with carotid IMT, a marker of cardiovascular disease. These findings may help future studies target women with early-onset VMS, in whom these symptoms may be most relevant to the pathophysiology of cardiovascular disease.