Vasomotor Symptoms and Mortality: The Rancho Bernardo Study
Objective: The purpose of this study was to examine the associations of vasomotor symptoms with risk of all-cause, cardiovascular disease (CVD), and coronary heart disease (CHD) mortality in community-dwelling older women, with a mean age of 69 years.
Methods: This prospective population-based study included 867 postmenopausal women who provided lifestyle and menopause-related history at the 1984 to 1987 visit of the Rancho Bernardo Study and answered a 1989 mailed questionnaire on menopause and vasomotor symptoms. Ninety-eight percent were followed for vital status through July 2004.
Results: Overall, 73% reported hot flashes, of whom 39% also reported night sweats. During the 11.5-year average follow-up, there were 405 deaths, of which 194 were attributed to CVD and 71 to CHD. Hot flashes alone were not associated with all-cause mortality, but women who, in addition to hot flashes, also had night sweats had an almost 30% (hazard ratio [HR], 0.72; 95% CI, 0.55–0.94) lower all-cause mortality risk compared with women without this symptom, independent of body mass index, past or current use of estrogen or progestin, physical exercise, and smoking habit. There was a similar lower risk of CVD and CHD mortality in women with night sweats when adjusted for past or current use of estrogen or progestin (HR, 0.62; 95% CI, 0.42-0.92 and HR, 0.51; 95% CI, 0.26–0.99, respectively). These associations were independent of hormone use but were no longer significant after adjusting for body mass index, physical exercise, and smoking.
Conclusions: Reported night sweats at menopause are associated with reduced risk of death over the following 20 years, independent of multiple risk factors including past or current use of postmenopausal estrogen therapy.
Hot flashes, the most common vasomotor symptom, are reported at some time by most perimenopausal and postmenopausal women and persist well into their 60s in many women. Night sweats, reported by approximately half of postmenopausal women, are thought to reflect more severe hot flashes, although there is some evidence that they have a different etiology and may have more severe consequences related to impaired sleep.
Vasomotor symptoms are viewed largely as a symptom affecting quality of life and are the leading reason women seek menopause-related health care. Recently, however, vasomotor symptoms have also been found to be associated with a less favorable cardiovascular risk profile and atherosclerosis. It is speculated that vasomotor symptoms may be a marker for a more hypoestrogenic state, which has been associated with impaired endothelial function, but there is no evidence that women with hot flashes have lower circulating estrogen levels than do women without hot flashes. It has also been suggested that the exclusion of women with severe vasomotor symptoms from large clinical trials of postmenopausal estrogen therapy, such as the Women's Health Initiative, explains why estrogen was not cardioprotective, in that such women are more likely to benefit from a treatment to increase their estrogen levels. We are not aware of previous publications examining the association of hot flashes and night sweats with mortality in postmenopausal women.
The purpose of this study was to examine the prospective association of vasomotor symptoms with risk of all-cause, cardiovascular disease (CVD), and coronary heart disease (CHD) mortality in a large, population-based sample of older postmenopausal women.
Abstract and Introduction
Abstract
Objective: The purpose of this study was to examine the associations of vasomotor symptoms with risk of all-cause, cardiovascular disease (CVD), and coronary heart disease (CHD) mortality in community-dwelling older women, with a mean age of 69 years.
Methods: This prospective population-based study included 867 postmenopausal women who provided lifestyle and menopause-related history at the 1984 to 1987 visit of the Rancho Bernardo Study and answered a 1989 mailed questionnaire on menopause and vasomotor symptoms. Ninety-eight percent were followed for vital status through July 2004.
Results: Overall, 73% reported hot flashes, of whom 39% also reported night sweats. During the 11.5-year average follow-up, there were 405 deaths, of which 194 were attributed to CVD and 71 to CHD. Hot flashes alone were not associated with all-cause mortality, but women who, in addition to hot flashes, also had night sweats had an almost 30% (hazard ratio [HR], 0.72; 95% CI, 0.55–0.94) lower all-cause mortality risk compared with women without this symptom, independent of body mass index, past or current use of estrogen or progestin, physical exercise, and smoking habit. There was a similar lower risk of CVD and CHD mortality in women with night sweats when adjusted for past or current use of estrogen or progestin (HR, 0.62; 95% CI, 0.42-0.92 and HR, 0.51; 95% CI, 0.26–0.99, respectively). These associations were independent of hormone use but were no longer significant after adjusting for body mass index, physical exercise, and smoking.
Conclusions: Reported night sweats at menopause are associated with reduced risk of death over the following 20 years, independent of multiple risk factors including past or current use of postmenopausal estrogen therapy.
Introduction
Hot flashes, the most common vasomotor symptom, are reported at some time by most perimenopausal and postmenopausal women and persist well into their 60s in many women. Night sweats, reported by approximately half of postmenopausal women, are thought to reflect more severe hot flashes, although there is some evidence that they have a different etiology and may have more severe consequences related to impaired sleep.
Vasomotor symptoms are viewed largely as a symptom affecting quality of life and are the leading reason women seek menopause-related health care. Recently, however, vasomotor symptoms have also been found to be associated with a less favorable cardiovascular risk profile and atherosclerosis. It is speculated that vasomotor symptoms may be a marker for a more hypoestrogenic state, which has been associated with impaired endothelial function, but there is no evidence that women with hot flashes have lower circulating estrogen levels than do women without hot flashes. It has also been suggested that the exclusion of women with severe vasomotor symptoms from large clinical trials of postmenopausal estrogen therapy, such as the Women's Health Initiative, explains why estrogen was not cardioprotective, in that such women are more likely to benefit from a treatment to increase their estrogen levels. We are not aware of previous publications examining the association of hot flashes and night sweats with mortality in postmenopausal women.
The purpose of this study was to examine the prospective association of vasomotor symptoms with risk of all-cause, cardiovascular disease (CVD), and coronary heart disease (CHD) mortality in a large, population-based sample of older postmenopausal women.
Source...