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Trajectories of Vasomotor Symptoms and Carotid Intima Media Thickness in the Study of Women’s Health across the Nation
Thurston RC, El Khoudary SR, Tepper PG, Jackson EA, Joffe H, Chen Y-H and Matthews KA
Stroke, Published Online

Emerging work has linked menopausal vasomotor symptoms (VMS) to subclinical cardiovascular disease (CVD) among women. However, these studies typically examine VMS at one time point in relation to CVD risk indicators. The menopause transition can last for over a decade, and VMS are highly dynamic over this transition. To date no studies have considered how temporal patterns of VMS may relate to subclinical CVD. 

Dr. Rebecca Thurston and her colleagues tested how temporal patterns of VMS assessed over 13 years were related to carotid intima media thickness (IMT), a subclinical CVD indicator, among midlife women.  The Study of Women’s Health across the Nation (SWAN) is a longitudinal cohort study of midlife women. Using data from that study, Dr. Thurston studied 811 white, black, Hispanic, and Chinese participants with a well-characterized menopausal status who had completed measures of VMS, a blood draw, and physical measures approximately annually for 13 years. The women underwent a carotid artery ultrasound at the 13th study year to characterize IMT.

Four trajectories of VMS were identified by trajectory analysis (consistently high, early-onset, late-onset, persistently low VMS) and tested in relation to IMT in linear regression models.  Dr. Thurston and her colleagues found that women with VMS early in the menopause transition had higher mean IMT and maximal IMT than those with consistently low VMS across the transition. The investigators also noted that associations were not accounted for by demographic factors nor by CVD risk factors. 

This study is unique in that the investigators tested trajectories of VMS in relation to subclinical CVD.  Results can signal to women in need of early CVD risk reduction.  Findings on VMS and CVD may ultimately be used to further understand the pathophysiology of CVD in women, as well as assist predicting future CVD risk among midlife women.

Contributors:
Rebecca C. Thurston, PhD, and Karen A. Matthews, PhD (Department of Psychiatry, University of Pittsburgh School of Medicine)

Samar R. El Khoudary, PhD, Ping Guo Tepper, PhD and Hsiang-Yu Chen, MS (Department of Epidemiology, University of Pittsburgh Graduate School of Public Health) 

Elizabeth A. Jackson, MD (Department of Medicine, University of Michigan School of Medicine) 

Hadine Joffe, MD, MS (Department of Psychiatry, Brigham and Women’s Hospital and Dana Farber Cancer Institute)

This article appears in the journal Stroke.  To view the abstract, click here.