Vasomotor symptoms and coronary artery calcium in postmenopausal women

Abstract

Objective: We assessed whether vasomotor symptoms (VMS) are associated with coronary artery calcium (CAC) and how hormone therapy (HT) may influence this association.

Methods: Participants were a subset of women aged 50 to 59 years with a history of hysterectomy who were enrolled in the Women's Health Initiative (WHI) estrogen-alone clinical trial and underwent a CT scan of the chest at the end of the trial to determine CAC. Participants provided information about VMS (hot flashes and/or night sweats), as well as HT use, on self-administered questionnaires at trial baseline.

Results: The sample consisted of 918 women with a mean (SD) age of 55.1 (2.8) years at WHI randomization and 64.8 (2.9) years at CAC ascertainment. The prevalence of a CAC score higher than 0 was 46%, whereas the prevalence of a CAC score of 10 or higher and higher than 100 was 39% and 19%, respectively. At randomization, 77% reported a history of any VMS at any time before or at enrollment in the WHI, whereas 20% reported any VMS present only at enrollment. Compared with those without a history of any VMS and after adjustment for potential confounders, a history of any VMS at any time up to and including WHI enrollment was associated with significantly reduced odds for CAC higher than 0 (odds ratio, 0.66; 95% CI, 0.45-0.98). Moreover, as duration of HT increased, the inverse association between any VMS and CAC moved toward the null.

Conclusions: A history of any VMS was significantly associated with reduced odds for CAC independent of traditional cardiovascular disease risk factors and other relevant covariates. This association seems to be influenced by duration of HT.

Figure 1. Multivariable Associations between the History of Any Vasomotor Symptoms and the Presence of Coronary Artery Calcium

316 (45.1%) of participants with a history of any VMS had a CAC score > 0. 105(50.5%) of participants with no history of any VMS had a CAC score > 0.

Figure 2. Multivariable Associations between History of Any Vasomotor Symptoms for Women with and without Vasomotor Symptoms at Enrollment and the Presence of Any Coronary Artery Calcium

246 (45.2%) of participants with a history of any VMS and did report VMS at enrollment had a CAC score > 0. 80 (43.7%) of participants with a history of any VMS and reported no VMS at enrollment had a CAC score > 0. 92 (51.1%) of participants with no history of any VMS and reported no VMS at enrollment had a CAC score > 0. Note that 28 participants reported VMS at enrollment had either missing(n=5) or reported "no" to ever having VMS (n=25). For this analysis, these women were coded as a history of any VMS and reporting VMS at enrollment

Figure 3. Multivariable Association between the Presence of Any Vasomotor Symptoms and the Presence of Coronary Artery Calcium (Modified by Hormone Therapy Duration)

Adjusted for age, ethnicity, ethnicity, income, education, smoking, diabetes, dyslipidemia, BMI, SBP, DBP, family history of MI, CEE treatment, bilateral oophorectomy and hormone therapy use 129 (43.7%) of participants with a history of any VMS and no prior HT use had a CAC score > 0. 62 (49.2%) of participants with no history of any VMS and no prior HT use had a CAC score > 0. 187 (46.1%) of participants with a history of any VMS and prior HT use had a CAC score > 0. 43(52.4%) of participants with no history of any VMS and prior HT use had a CAC score > 0.