Menopausal women with frequent or persistent hot flashes face increased risk of heart attack, stroke

Women with frequent hot flashes in early midlife or those experienced persistently over the course of the menopause transition have increased risk for clinical cardiovascular disease events later in life, Rebecca Thurston, lead author of a study, told MEA WorldWide (MEAWW)


                            Menopausal women with frequent or persistent hot flashes face increased risk of heart attack, stroke

Frequent hot flashes, experienced by women during menopause transition, could double the risk of future heart attacks and strokes. Hot flashes are the most common symptom of the menopausal transition.

According to Mayo Clinic, during a hot flash, a woman might experience a feeling of warmth spreading through the upper body and face. It could also include rapid heartbeat, perspiration, and a flushed appearance, among others.

Researchers analyzed hot flashes regularly throughout the menopause transition and collected information on cardiovascular disease events as women aged. They also examined whether hot flashes early in the transition or persistent hot flashes over the transition impacted cardiovascular disease (CVD) risk. 

The researchers found that frequent, as well as persistent, hot flashes over the menopausal transition translated into a higher risk of having a cardiovascular event in the future. According to the researchers, they discovered this association was not explained by standard CVD risk factors.

“We find here that women with frequent hot flashes in early midlife (for example, in their 40’s and early 50’s) or those experienced persistently over the course of the menopause transition have increased risk for clinical cardiovascular disease events later in life, such as heart attacks and strokes, and that this was not explained by things like blood pressure, diabetes, obesity, exercise, or smoking (our 'usual suspects'),” Dr. Rebecca Thurston, lead author of the study from the University of Pittsburgh, told MEA WorldWide (MEAWW).

“Given the fact that these links were not explained by our usual suspects, the underlying mechanisms linking the two remain to be identified, but may involve pathways such as the autonomic nervous system, stress hormones, or other biological processes,” added Dr. Thurston, who is the Director of the Women’s Biobehavioral Health Research Program at University of Pittsburgh.

Hot flashes are a common symptom of the menopausal transition and can last for several years. According to the National Institute on Aging, the earlier in life hot flashes begin, the longer one could experience them.

A 2014 Study of Women’s Health Across the Nation (SWAN), a longitudinal 20-year study of the menopause transition, had estimated the duration of hot flashes. The findings, published in JAMA Internal Medicine, said frequent hot flashes could last for over seven years during the menopausal transition, and they may last longer for African American women.

The current study is also based on data from SWAN. According to the analysis, frequent hot flashes at the beginning of the study were associated with a doubling of the risk of clinical CVD events, and persistent hot flashes over the study, with an 80% increased risk of clinical cardiovascular disease events in the subsequent 20 years.

Frequent hot flashes at the beginning of the study were associated with a doubling of the risk of clinical cardiovascular disease events, and persistent hot flashes over the study with an 80% increased risk of clinical CVD events in the subsequent 20 years. (Getty Images)

The findings of the latest study were presented during the annual meeting of the North American Menopause Society (NAMS). “With heart disease being the number one killer of women, it is critical that we understand its many different risk factors to help create more preventative and treatment strategies for women transitioning through menopause,” said Dr. Stephanie Faubion, NAMS medical director.

Previous studies have suggested an association between hot flashes and cardiovascular disease. But little research linked hot flashes to “hard” clinical CVD events like heart attacks and strokes, said the team. Most studies have also relied upon recalled measures as hot flashes from years earlier - that is, where women were asked to recall their hot flashes over months or years - which can be biased by memory. 

The SWAN, explained the researchers, is uniquely positioned to confirm this link because it assessed hot flashes regularly throughout the menopause transition. Accordingly, say the researchers, the latest findings which measured “clinical CVD outcomes” is the strongest evidence of frequent or persistent hot flashes associated with higher CVD event risk.

“Prior work - including our own - has linked hot flashes to CVD risk factors (such as obesity, blood pressure, diabetes) or proxy measures (not actual events) of CVD - subclinical measures of CVD that image the vasculature (arrangement of blood vessels in an organ or in a part of the body) among those without frank CVD. Very little prior work has linked hot flashes to clinical CVD – that is, hard events such as heart attacks and strokes. We were able to look at hot flashes measured over the course of the menopause transition in relation to clinical CVD outcomes such as heart attack, stroke, and heart failure over 20 years,” Dr. Thurston told MEAWW.

“Thus, this is the strongest test of whether hot flashes are associated with actual clinical CVD events, such as heart attacks and strokes, which represent the most clinically relevant outcome,” said Dr. Thurston.
 
She explained that for women, these results are important because experts are not as good at predicting which women at midlife will go on to have clinical CVD later in life (traditionally it has been done better in men). Therefore, frequent hot flashes provide an additional clue. 

“We do not know if treating the hot flashes will prevent CVD. But these results do indicate that women with many or persistent hot flashes should engage in all of the standard CVD risk-reduction behaviors,” added Dr. Thurston.

“What we think is that women with a lot of hot flashes or persistent hot flashes over the menopause transition should stop smoking if they smoke, eat well, exercise, get their regular, recommended check-ups, and take medications as prescribed. Now is the time for women to prioritize their health. Often women are encouraged to put others first – their partners, children, and parents. But engaging in those healthy behaviors for herself is very important at midlife to prevent disease later in life. This is particularly important among our women with lots of flashes,” she told MEAWW.

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