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Menopausal symptoms reported at onset of menopause not associated with increased risk for CVD events

Szmuilowicz ED. Menopause. 2011;doi:10.1097/gme.0b013e3182014849.

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Vasomotor symptoms that occur early in menopause do not appear to be associated with increased risk for CVD and are instead associated with decreased risks for total CVD events, stroke and all-cause mortality. Symptoms that occur late in menopause, however, are linked to increased coronary heart disease risk and all-cause mortality, researchers reported in a new study.

Emily D. Szmuilowicz, MD, MS, and colleagues conducted a study to investigate associations between menopausal vasomotor symptoms, clinical CVD events and all-cause mortality in a group of more than 60,000 women from the Women's Health Initiative (WHI) Observational Study. Their study focused on incident CVD events and all-cause mortality in four groups of women:

• Women with no vasomotor symptoms at menopause onset and no symptoms at WHI enrollment (reference group; n=18,799).
• Women with vasomotor symptoms at menopause onset but not at WHI enrollment (early symptoms; n=24,753).
• Women with vasomotor symptoms at menopause onset and at WHI enrollment (persistent symptoms; n=15,084).
• Women with vasomotor symptoms at WHI enrollment but not at menopause onset (late symptoms; n=1,391).

"Our study is the first to investigate the relationships between menopausal symptoms and CV events, and the first to examine the timing of menopausal symptoms," Szmuilowicz, a clinical instructor of medicine at Northwestern University, said in an interview. "The key finding of the study is that the menopausal symptoms experienced by the majority of women at mid-life do not indicate an increased risk for CVD in the future."

Compared with women who had no vasomotor symptoms, women who exhibited early symptoms had a HR of 0.94 for major coronary heart disease, 0.83 for stroke, 0.89 for total CVD and 0.92 for all-cause mortality. Women who had late vasomotor symptoms had HRs of 1.32 for major CHD, 1.14 for stroke, 1.23 for total CVD and 1.29 for all-cause mortality compared with women who had no symptoms. The researchers found no significant association with clinical CVD events among women who had persistent vasomotor symptoms.

"The predictive value of vasomotor symptoms for clinical CVD events may vary with the onset of vasomotor symptoms at different stages of menopause," the researchers concluded. “Future studies will also be necessary to investigate whether vasomotor symptoms that develop for the first time in later postmenopausal years represent a pathophysiologic process distinct from the classic perimenopausal vasomotor symptoms."

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