CVD, stroke risks increase with number of menopause symptoms

Posted on September 29, 2020

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Source: Healio

Women who reported two or more moderate to severe menopause symptoms had increased risks for cardiovascular disease and stroke, but vasomotor symptom severity did not affect risk, according to data from the WHI Calcium and Vitamin D trial.

Researchers analyzed data collected during the Women’s Health Initiative-Calcium and Vitamin D trial (n = 20,050), a double-blind, randomized, placebo-controlled study in which women aged 50 to 79 years received 400 IU of 25-hydroxyvitamin D and 1,000 mg of elemental calcium per day, with researchers analyzing the effect of the supplements on health outcomes.

Participants self-reported menopause symptoms, including vasomotor symptoms, such as hot flashes and night sweats. Other menopause symptoms reported were dizziness, heart racing, tremors, feeling restless, feeling tired, difficulty concentrating, forgetfulness, mood swings, vaginal dryness, breast tenderness, headaches and waking up several times at night. Severity of symptoms was assessed at baseline with a questionnaire. Researchers examined occurrences of CVD, stroke, hip fracture, colorectal cancer, invasive breast cancer, all-cause mortality, coronary heart disease and a global index that included hip fracture, cancer and death outcomes (median follow-up, 7 years).

The data showed no association between severity of vasomotor symptoms and any health outcomes included in the trial. However, women who reported two or more menopause symptoms were at a higher risk for total CVD and stroke compared with women with no symptoms. Women who reported one menopause symptom also had an elevated risk for stroke compared with women with no symptoms.

Participants who reported moderate or severe symptoms of dizziness, heart racing, restlessness, feeling tired, difficulty concentrating, forgetfulness and headaches or migraines were at higher risk for total CVD. The associations did not change after adjusting for the calcium and vitamin D supplement in the trial.

PERSPECTIVE
Holly L. Thacker MD, FACP, CCD, NCMP

Holly L. Thacker MD, FACP, CCD, NCMP)

This study reinforces that women with moderate to severe menopausal symptoms need medical evaluation and treatment, and women with more moderate to severe menopausal symptoms have higher risks of cardiovascular disease and stroke. Not surprising, randomization to calcium and vitamin D did not mitigate those symptoms or increased cardiovascular risk.

All midlife women deserve cardiac risk assessment, which is the No. 1 cause of death; however, those women with more intense symptoms may be at more risk due to hormonal deficiency. Women who have palpitations, hypertension and other cardiovascular symptoms still deserve cardiovascular work up, but many times do better when treated with hormone therapy.

Midlife is an excellent time to assess not only cardiovascular risk, but osteoporosis risk, breast cancer risk and general health habits.

The “global index” was not a validated instrument, and as such, clinically, that’s much less helpful than the long-term data we have that show that women treated with menopausal hormone therapy within 10 years of menopause and for 5 or more years live longer!

In 2020, there is no excuse to not evaluate and treat symptomatic women, and for most women, the benefits of hormone therapy outweigh risks.