A large longitudinal study from Australia has found that women who often experience vasomotor menopausal symptoms such as hot flushes and night sweats appear to be at greater risk of coronary heart disease (CHD).

Women in the Australian Longitudinal Study on Women’s Health (ALSWH), born between 1946 and 1951, were followed up at three-year intervals for 14 years. They were sent a series of six questionnaires between 1996 and 2010. In each survey they were asked whether they had had heart disease diagnosed.

They were also asked about hot flushes and night sweats. The responses they could select from were: never, rarely, sometimes or often.

After exclusions and non-responses, 11,442 women who provided sufficient data for analysis on both vasomotor menopausal symptoms and CHD were analysed. Of these, 187 reported incident CHD or had died of CHD.

Demographic factors (e.g. high BMI, lower educational achievement, smoking) were associated with the incidence and severity of symptoms. Vasomotor menopausal symptoms were more common and severe among less healthy women.

In an age-adjusted analysis women who had vasomotor menopausal symptoms had a more than two-fold risk of CHD:

• Hot flushes: OR 2.18 (95% CI: 1.49-3.18) P < 0.001 for trend

• Night sweats: OR 2.38 (95% CI: 1.62-3.50) P < 0.001 for trend 

After controlling for smoking, alcohol, BMI, diabetes, physical activity and education, the risks were attenuated but remained significant. The risk of CHD was:

• 70% higher in those reporting hot flushes often: OR 1.70 (95% CI: 1.16-2.51 P < 0.01 for trend)

• 84% higher in those reporting night sweats often OR 1.84 (95% CI: 1.24-2.73 P < 0.004 for trend)

To date the evidence suggesting that women who experience significant vasomotor menopausal symptoms have a higher risk of CHD has been mixed.

In this study, there was no way of controlling for individual specific CHD risks such as lipid anomaly or family history of CHD. Ethnicity, which is a significant factor in menopausal studies, was not addressed.

Nevertheless a significant association was demonstrated particularly for night sweats.

The cause of this association is not known though the authors speculate on adverse inflammatory and endothelial factors.

In my own practice I will look at CHD risk a little more closely in women who have a bad climacteric.

Dr Chris Barclay