Department of Obstetrics and Gynecology, and Department of Biomedical and Clinical Sciences Linköping University Linköping Sweden.
Unit of Cardiovascular and Nutritional Epidemiology Institute of Environmental Medicine, Karolinska Institutet Stockholm Sweden.
J Am Heart Assoc. 2024 Sep 3;13(17):e033648. doi: 10.1161/JAHA.123.033648. Epub 2024 Aug 21.
Menopausal vasomotor symptoms (VMS) are increasingly emphasized as a potentially important cardiovascular risk factor, but their role is still unclear. We assessed the association between VMS and subclinical atherosclerotic cardiovascular disease in peri- and postmenopausal women.
Using a cross-sectional study design, questionnaire data were collected from a population-based sample of women aged 50 to 64. The questionnaire asked whether menopause was/is associated with bothersome VMS. A 4-point severity scale was used: (1) never, (2) mild, (3) moderate, and (4) severe. The VMS duration and time of onset were also assessed. Associations with subclinical atherosclerotic cardiovascular disease, detected via coronary computed tomography angiography, coronary artery calcium score, and carotid ultrasound were assessed using the outcome variables "any coronary atherosclerosis," "segmental involvement score >3," "coronary artery calcium score >100," and "any carotid plaque," using logistic regression. Covariate adjustments included socioeconomic, lifestyle, and clinical factors. Of 2995 women, 14.2% reported ever severe, 18.1% ever moderate, and 67.7% ever mild/never VMS. Using the latter as reference, ever severe VMS were significantly associated with coronary computed tomography angiography-detected coronary atherosclerosis (multivariable adjusted odds ratio, 1.33 [95% CI, 1.02-1.72]). Corresponding results for ever severe VMS persisting >5 years or beginning before the final menstrual period were 1.50 (95% CI, 1.07-2.11) and 1.66 (95% CI, 1.10-2.50), respectively. No significant association was observed with segmental involvement score >3, coronary artery calcium score >100, or with any carotid plaque.
Ever occurring severe, but not moderate, VMS were significantly associated with subclinical coronary computed tomography angiography-detected atherosclerosis, independent of a broad range of cardiovascular risk factors and especially in case of long durations or early onset.
绝经后血管舒缩症状（VMS）作为潜在的重要心血管危险因素越来越受到关注，但作用仍不明确。本研究评估了 VMS 与围绝经期和绝经后妇女亚临床动脉粥样硬化性心血管疾病之间的关系。
采用横断面研究设计，从 50 至 64 岁的人群中收集问卷数据。问卷询问绝经是否伴有令人烦恼的 VMS。采用 4 分严重程度量表：（1）从不，（2）轻度，（3）中度，和（4）重度。还评估了 VMS 的持续时间和发病时间。通过冠状动脉计算机断层血管造影、冠状动脉钙评分和颈动脉超声检测亚临床动脉粥样硬化性心血管疾病，并使用逻辑回归评估与“任何冠状动脉粥样硬化”、“节段受累评分＞3”、“冠状动脉钙评分＞100”和“任何颈动脉斑块”等结局变量的相关性。协变量调整包括社会经济、生活方式和临床因素。在 2995 名女性中，14.2%报告曾有严重 VMS，18.1%报告曾有中度 VMS，67.7%报告曾有轻度/无 VMS。以后者为参照，曾有严重 VMS 与冠状动脉计算机断层血管造影检测到的冠状动脉粥样硬化显著相关（多变量校正比值比，1.33 [95%CI，1.02-1.72]）。曾有严重 VMS 持续＞5 年或绝经前开始的相应结果分别为 1.50（95%CI，1.07-2.11）和 1.66（95%CI，1.10-2.50）。与节段受累评分＞3、冠状动脉钙评分＞100 或任何颈动脉斑块均无显著相关性。
曾发生的严重（而非中度）VMS 与亚临床冠状动脉计算机断层血管造影检测到的动脉粥样硬化显著相关，独立于广泛的心血管危险因素，尤其是在持续时间较长或发病较早的情况下。
