Department of Psychiatry University of Pittsburgh School of Medicine Pittsburgh PA.
Department of Epidemiology University of Pittsburgh Graduate School of Public Health Pittsburgh PA.
J Am Heart Assoc. 2021 Feb 2;10(3):e017416. doi: 10.1161/JAHA.120.017416. Epub 2021 Jan 20.
Background Cardiovascular disease (CVD) in women has unique features, including associations with reproductive factors that are incompletely understood. Vasomotor symptoms (VMS), the classic menopausal symptom, are linked to CVD risk factors and subclinical CVD. Evidence linking VMS to CVD events is limited. We tested whether frequent and/or persistent VMS were associated with increased risk for fatal and nonfatal CVD events in SWAN (Study of Women's Health Across the Nation). Methods and Results A total of 3083 women, aged 42 to 52 years at baseline, underwent up to 16 in-person visits over 22 years. Assessments included questionnaires on VMS frequency (0, 1-5, or ≥6 days/2 weeks), physical measures, phlebotomy, and reported CVD events (myocardial infarction, stroke, heart failure, and revascularization). A subset of events was adjudicated via medical record. Death certificates were obtained. Relationships between baseline VMS or persistent VMS over the follow-up (proportion of visits with frequent VMS) with combined incident nonfatal and fatal CVD were tested in Cox proportional hazards models adjusted for demographics, medication use, and CVD risk factors. Participants experienced 231 CVD events over the follow-up. Women with frequent baseline VMS had an elevated risk of subsequent CVD events (relative to no VMS; ≥6 days: hazard ratio [HR] [95% CI], 1.51 [1.05-2.17], =0.03; 1-5 days: HR [95% CI], 1.02 [0.75-1.39], =0.89, multivariable). Women with frequent VMS that persisted over time also had an increased CVD event risk (>33% versus ≤33% of visits: HR [95% CI], 1.77 [1.33-2.35], <0.0001, multivariable). Conclusions Frequent and persistent VMS were associated with increased risk of later CVD events. VMS may represent a novel female-specific CVD risk factor.
背景
心血管疾病（CVD）在女性中具有独特的特征，包括与生殖因素的关联，而这些关联尚未完全被理解。血管舒缩症状（VMS）是典型的更年期症状，与 CVD 危险因素和亚临床 CVD 有关。将 VMS 与 CVD 事件联系起来的证据有限。我们在 SWAN（全美女性健康研究）中测试了频繁和/或持续的 VMS 是否与致命和非致命 CVD 事件的风险增加有关。
方法和结果
共有 3083 名年龄在 42 至 52 岁的女性，在基线时接受了长达 22 年的 16 次面对面访问。评估包括 VMS 频率（0、1-5 或≥6 天/2 周）、体格测量、采血和报告的 CVD 事件（心肌梗死、中风、心力衰竭和血运重建）的问卷调查。通过医疗记录对部分事件进行裁决。获得死亡证明。在 Cox 比例风险模型中测试了基线 VMS 或随访期间持续 VMS（频繁 VMS 就诊的比例）与合并非致命性和致命性 CVD 事件之间的关系，该模型调整了人口统计学、药物使用和 CVD 危险因素。参与者在随访期间经历了 231 例 CVD 事件。基线时有频繁 VMS 的女性随后发生 CVD 事件的风险增加（与无 VMS 相比；≥6 天：风险比[HR] [95%CI]，1.51 [1.05-2.17]，=0.03；1-5 天：HR [95%CI]，1.02 [0.75-1.39]，=0.89，多变量）。随着时间的推移，频繁的 VMS 持续存在的女性也有更高的 CVD 事件风险（>33%与≤33%就诊次数：HR [95%CI]，1.77 [1.33-2.35]，<0.0001，多变量）。
结论
频繁和持续的 VMS 与以后发生 CVD 事件的风险增加有关。VMS 可能是一种新的女性特异性 CVD 危险因素。
