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Early-onset vasomotor symptoms linked with endothelial dysfunction
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SAN DIEGO — Women who experience vasomotor symptoms earlier in life may have poor endothelial function, as indicated by lower flow-mediated dilation, according to new data from the WISE and MsHEART studies.
WISE included 104 postmenopausal women (mean age, 67 years) who had their ovaries and were not using hormone therapy at enrollment. All participants underwent coronary angiography due to ischemia and assessment of flow-mediated dilation by brachial artery ultrasound to measure endothelial dysfunction. The women self-reported history of vasomotor symptoms, including hot flashes and night sweats. Symptoms were classified as none/never; early onset, beginning at age 40 years or younger; and traditional onset, beginning at age 42 or older.
At baseline, median flow-mediated dilation was 1.56%. and ranged from –19.9% to 27.6%.
Women who reported early-onset vasomotor symptoms had significantly lower flow-mediated dilation (β = –4.43; P = .038) compared with women who reported traditional-onset symptoms. No difference was observed between women who reported traditional-onset symptoms and those who reported no symptoms (β = 1.21; P = .42).
MsHEART included 175 perimenopausal and postmenopausal women (mean age, 54 years) who reported no history of smoking, CVD or use of hormone therapy, beta-blockers, calcium channel blockers, insulin and antidepressants. The women underwent brachial artery ultrasound to measure flow-mediated dilation and physiologic hot flash monitoring for 24 hours.
The women experienced an average of eight hot flashes during the 24-hour monitoring period. Mean flow-mediated dilation was 6.3%.
In this study, the researchers observed significant variation in the link between flow-mediated dilation and hot flashes according to age (P = .02). Women aged 52 years and younger had significantly lower flow-mediated dilation and a greater number of hot flashes (β = –0.13; P = .04). However, this association was not observed among women aged 53 to 56 years (P = .2) or 57 years and older (P = .48).
Adjustment for factors including age, race/ethnicity, BMI, hormone use and obstructive CAD did not significantly alter the results in WISE or MsHEART.
Rebecca C. Thurston
"In both of these studies, we found that vasomotor symptoms were associated with lower flow-mediated dilation, indicating poor endothelial function, and in both of these studies this association varied by age," Rebecca C. Thurston, PhD, associate professor of psychiatry, psychology and epidemiology at the University of Pittsburgh, said during a press briefing held prior to the ACC Scientific Sessions. "… This indicates that early vasomotor symptoms may be a mechanistic pathway for endothelial dysfunction, or could potentially serve as a marker for adverse changes that women [experience] in their CV systems early in midlife."
Thurston also noted that these results may help identify subgroups of women who would benefit from targeted CVD prevention strategies. – by Adam Taliercio and Erik Swain
References:
Thurston R, et al. Poster 1246-115.
Thurston R, et al. Poster 1246-116. Both presented at: American College of Cardiology Scientific Sessions; March 14-16, 2015; San Diego.
Disclosure: The MsHEART and WISE studies were sponsored by the National Heart, Lung and Blood Institute. Thurston reports no relevant financial disclosures.
Perspective
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Mary Norine Walsh, MD, FACC
Endothelial function is important as far as demonstrating risk for CVD subsequently, but the identification of the tie-in of vasomotor dysfunction that occurs in perimenopausal women and endothelial dysfunction is novel. It is another risk factor for us to be aware of as we try to take a good history. We know that obstetric history is an important factor for us to be considering in addition to the other risk factors such as hypertension, diabetes, etc. We know that preeclampsia and eclampsia have been demonstrated to be related to subsequent CVD. I think these data underscore that CV physicians need to incorporate questions about vasomotor symptoms into their histories for women to identify women at risk.
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