OBJECTIVE: Emerging evidence suggests that women with menopausal vasomotor symptoms (VMS) have increased cardiovascular disease (CVD) risk as measured by surrogate markers. We investigated the relationships between VMS and clinical CVD events and all-cause mortality in the Women's Health Initiative Observational Study (WHI-OS). METHODS: We compared the risk of incident CVD events and all-cause mortality between four groups of women (total N = 60,027): (1) no VMS at menopause onset and no VMS at WHI-OS enrollment (no VMS [referent group]), (2) VMS at menopause onset but not at WHI-OS enrollment (early VMS), (3) VMS at both menopause onset and WHI-OS enrollment (persistent VMS [early and late]), and (4) VMS at WHI-OS enrollment but not at menopause onset (late VMS). RESULTS: For women with early VMS (n = 24,753), compared with no VMS (n = 18,799), hazard ratios (95% CIs) in fully adjusted models were as follows: major coronary heart disease (CHD), 0.94 (0.84-1.06); stroke, 0.83 (0.72-0.96); total CVD, 0.89 (0.81-0.97); and all-cause mortality, 0.92 (0.85-0.99). For women with persistent VMS (n = 15,084), there was no significant association with clinical events. For women with late VMS (n = 1,391), compared with no VMS, hazard ratios (95% CIs) were as follows: major CHD, 1.32 (1.01-1.71); stroke, 1.14 (0.82-1.59); total CVD, 1.23 (1.00-1.52); and all-cause mortality, 1.29 (1.08-1.54). CONCLUSIONS: Early VMS were not associated with increased CVD risk. Rather, early VMS were associated with decreased risk of stroke, total CVD events, and all-cause mortality. Late VMS were associated with increased CHD risk and all-cause mortality. The predictive value of VMS for clinical CVD events may vary with the onset of VMS at different stages of menopause. Further research examining the mechanisms underlying these associations is needed. Future studies will also be necessary to investigate whether VMS that develop for the first time in the later postmenopausal years represent a pathophysiologic process distinct from the classic perimenopausal VMS.
OBJECTIVE: Emerging evidence suggests that women with menopausal vasomotor symptoms (VMS) have increased cardiovascular disease (CVD) risk as measured by surrogate markers. We investigated the relationships between VMS and clinical CVD events and all-cause mortality in the Women's Health Initiative Observational Study (WHI-OS). METHODS: We compared the risk of incident CVD events and all-cause mortality between four groups of women (total N = 60,027): (1) no VMS at menopause onset and no VMS at WHI-OS enrollment (no VMS [referent group]), (2) VMS at menopause onset but not at WHI-OS enrollment (early VMS), (3) VMS at both menopause onset and WHI-OS enrollment (persistent VMS [early and late]), and (4) VMS at WHI-OS enrollment but not at menopause onset (late VMS). RESULTS: For women with early VMS (n = 24,753), compared with no VMS (n = 18,799), hazard ratios (95% CIs) in fully adjusted models were as follows: major coronary heart disease (CHD), 0.94 (0.84-1.06); stroke, 0.83 (0.72-0.96); total CVD, 0.89 (0.81-0.97); and all-cause mortality, 0.92 (0.85-0.99). For women with persistent VMS (n = 15,084), there was no significant association with clinical events. For women with late VMS (n = 1,391), compared with no VMS, hazard ratios (95% CIs) were as follows: major CHD, 1.32 (1.01-1.71); stroke, 1.14 (0.82-1.59); total CVD, 1.23 (1.00-1.52); and all-cause mortality, 1.29 (1.08-1.54). CONCLUSIONS: Early VMS were not associated with increased CVD risk. Rather, early VMS were associated with decreased risk of stroke, total CVD events, and all-cause mortality. Late VMS were associated with increased CHD risk and all-cause mortality. The predictive value of VMS for clinical CVD events may vary with the onset of VMS at different stages of menopause. Further research examining the mechanisms underlying these associations is needed. Future studies will also be necessary to investigate whether VMS that develop for the first time in the later postmenopausal years represent a pathophysiologic process distinct from the classic perimenopausal VMS.
Authors: Johan Svartberg; Denise von Mühlen; Donna Kritz-Silverstein; Elizabeth Barrett-Connor Journal: Menopause Date: 2009 Sep-Oct Impact factor: 2.953
Authors: Melonie Heron; Donna L Hoyert; Sherry L Murphy; Jiaquan Xu; Kenneth D Kochanek; Betzaida Tejada-Vera Journal: Natl Vital Stat Rep Date: 2009-04-17
Authors: Linda M Gerber; Lynnette Leidy Sievert; Katherine Warren; Thomas G Pickering; Joseph E Schwartz Journal: Menopause Date: 2007 Mar-Apr Impact factor: 2.953
Authors: Rebecca C Thurston; Kim Sutton-Tyrrell; Susan A Everson-Rose; Rachel Hess; Karen A Matthews Journal: Circulation Date: 2008-09-02 Impact factor: 29.690
Authors: Alison J Huang; Deborah Grady; Vanessa L Jacoby; Terri L Blackwell; Douglas C Bauer; George F Sawaya Journal: Arch Intern Med Date: 2008-04-28
Authors: Gerrie-Cor M Gast; Diederick E Grobbee; Victor J M Pop; Jules J Keyzer; Colette J M Wijnands-van Gent; Göran N Samsioe; Peter M Nilsson; Yvonne T van der Schouw Journal: Hypertension Date: 2008-04-07 Impact factor: 10.190
Authors: Pauliina Tuomikoski; Pia Ebert; Per-Henrik Groop; Petri Haapalahti; Hanna Hautamäki; Mats Rönnback; Olavi Ylikorkala; Tomi S Mikkola Journal: Obstet Gynecol Date: 2009-04 Impact factor: 7.661
Authors: Laura B Harrington; Marc Blondon; Mary Cushman; Andrew M Kaunitz; Jacques E Rossouw; Matthew A Allison; Lisa W Martin; Karen C Johnson; Jan Rosing; Nancy F Woods; Andrea Z LaCroix; Susan R Heckbert; Barbara McKnight; Nicholas L Smith Journal: Menopause Date: 2017-04 Impact factor: 2.953
Authors: Ping G Tepper; Maria M Brooks; John F Randolph; Sybil L Crawford; Samar R El Khoudary; Ellen B Gold; Bill L Lasley; Bobby Jones; Hadine Joffe; Rachel Hess; Nancy E Avis; Sioban Harlow; Daniel S McConnell; Joyce T Bromberger; Huiyong Zheng; Kristine Ruppert; Rebecca C Thurston Journal: Menopause Date: 2016-10 Impact factor: 2.953
Authors: Rebecca C Thurston; Karen A Matthews; Yuefang Chang; Nanette Santoro; Emma Barinas-Mitchell; Roland von Känel; Doug P Landsittel; J Richard Jennings Journal: Menopause Date: 2016-05 Impact factor: 2.953
Authors: Rebecca C Thurston; Samar R El Khoudary; Ping Guo Tepper; Elizabeth A Jackson; Hadine Joffe; Hsiang-Yu Chen; Karen A Matthews Journal: Stroke Date: 2015-11-17 Impact factor: 7.914
Authors: Jennifer L Gordon; David R Rubinow; Rebecca C Thurston; Julia Paulson; Peter J Schmidt; Susan S Girdler Journal: Menopause Date: 2016-11 Impact factor: 2.953
Authors: Alexis Nasr; Karen A Matthews; Maria M Brooks; Daniel S McConnell; Trevor J Orchard; Jeffrey Billheimer; Daniel J Rader; Samar R El Khoudary Journal: J Clin Lipidol Date: 2020-07-08 Impact factor: 4.766
Authors: Erin Foran Wolff; Yunxiao He; Dennis M Black; Eliot A Brinton; Mathew J Budoff; Marcelle I Cedars; Howard N Hodis; Rogerio A Lobo; Joann E Manson; George R Merriam; Virginia M Miller; Fredrick Naftolin; Lubna Pal; Nanette Santoro; Heping Zhang; S Mitchell Harman; Hugh S Taylor Journal: Fertil Steril Date: 2013-01-08 Impact factor: 7.329