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Researchers say migraine and menopause symptoms can increase the risk of cardiovascular disease. Fiordaliso/Getty Images
  • Hot flashes and night sweats, also known as vasomotor symptoms, affect nearly 7 in 10 midlife women, with severe symptoms adversely impacting daily life.
  • A new study suggests that Black adults as well as people with lower education levels, people who smoke, and people with a history of migraine or depression during early adulthood can have a higher risk of vasomotor symptoms later in life.
  • Researchers say identifying these factors in early adulthood between 18 and 30 years of age could help reduce the risk of vasomotor symptoms later in life.
  • Another study conducted by the same research group reports that women with a combined history of migraine and persistent vasomotor symptoms after the age of 40 years were at a two-fold higher risk of cardiovascular events.

Vasomotor symptoms, which include hot flashes and night sweats, are prevalent in midlife women.

While studies have characterized risk factors for vasomotor symptoms for women in this age group, it still isn’t certain whether factors that appear in early adulthood influence the risk of vasomotor symptoms.

Now, a new study published in the journal Menopause reports that socioeconomic factors and a history of depression or migraine in early adulthood may increase the risk of vasomotor symptoms in later life.

In addition, another study, also published in Menopause by the same research group, shows that the combined presence of vasomotor symptoms and migraine in midlife could increase the risk of cardiovascular disease later in life. The researchers reported that this association persisted after accounting for other cardiovascular risk factors.

While migraine headaches and vasomotor symptoms are individually linked to cardiovascular risk, the new research are among the first studies to examine their combined impact on cardiovascular disease.

Dr. Cheng-Han Chen, an interventional cardiologist and medical director of the Structural Heart Program at Memorial Care Saddleback Medical Center in California who was not involved in the studies, told Medical News Today that:

“[This population study] suggests that the combination of migraine and vasomotor symptoms may provide an early indication of a population that could benefit from more intensive risk factor intervention and modification in order to reduce their future risk. Further research can potentially examine whether more aggressive cardiovascular risk factor management of this particular population would actually lead to better health outcomes.”

Hot flashes and night sweats, referred to together as vasomotor symptoms, are a common occurrence in midlife women, affecting nearly 70% of this age group. These symptoms are typically observed during menopause.

Notably, these vasomotor symptoms tend to be severe or very frequent in about one-third of the affected women, having an adverse impact on their quality of life. Despite the widespread prevalence of vasomotor symptoms, the risk factors for vasomotor symptoms are not well understood.

While vasomotor symptoms are prominent during the period leading to and during menopause, factors influencing the predisposition for vasomotor symptoms could arise earlier in life. In one of the two studies published in Menopause, the researchers examined the risk factors for vasomotor symptoms that could be present during early adulthood.

In addition to their impact on quality of life, studies have shown that vasomotor symptoms are associated with an increased risk of cardiovascular disease. Researchers have also observed an association between migraine and vasomotor symptoms.

Moreover, migraine is also associated with an increased risk of cardiovascular disease. However, it is not known whether a combined history of migraine and vasomotor symptoms can increase the risk of cardiovascular disease.

In addition, it is unclear whether vasomotor symptoms can increase cardiovascular risk after accounting for known risk factors such as blood pressure, blood glucose and lipid levels, and smoking. Hence, the other study examined the impact of vasomotor symptoms and migraine headaches on cardiovascular risk.

Both studies included more than 1,900 women enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) study. This long-term study is designed to evaluate factors in young adulthood that can increase the risk of cardiovascular disease later in life.

The CARDIA study participants were between the ages of 18 and 30 at the time of enrollment. The participants were assessed for cardiovascular risk factors at enrollment and then every five years afterward. The last instance of data collection was 35 years after enrollment, when the participants were around 60 years old.

The study has also gathered data on vasomotor symptoms beginning with the visit 15 years after enrollment when the participants were about 40 years old. Data on vasomotor symptoms was then collected every five years.

The researchers determined the presence and severity of vasomotor symptoms based on the participants’ experiences of hot flashes or night sweats during the three-month period before each evaluation. Depending on the changes in the severity of these symptoms over time, the researchers classified the participants into groups experiencing minimal, increasing, or persistent vasomotor symptoms.

A salient feature of the two studies was that, unlike previous studies, they included women undergoing gynecological procedures or using hormone therapy.

In one of the studies, the researchers examined the relationship between a history of vasomotor symptoms and migraine, both individually and together, and the occurrence of cardiovascular events at 15 years after enrollment.

The cardiovascular events included in the study consisted of non-fatal and fatal cardiac events, including heart attacks, heart failure, and stroke. To account for other cardiovascular risk factors, the researchers measured blood pressure, blood cholesterol and glucose levels, body mass index, and tobacco use at the 15-year visit after enrollment.

The analysis was conducted after accounting for factors such as age, race, and reproductive factors, such as gynecological surgery, the use of oral contraceptives, or sex hormone therapy.

Only women who had a history of both migraine and persistent vasomotor symptoms were at a two-fold higher risk of cardiovascular events than other participants who did not have a history of both. Unlike previous studies, a history of either persistent vasomotor symptoms or migraine did not independently increase the likelihood of experiencing a cardiovascular event.

Further analysis revealed that the inclusion of cardiovascular risk factors such as smoking and blood glucose and cholesterol levels weakened the association between a combined history of persistent vasomotor symptoms and migraine and the risk of cardiovascular events. In other words, a history of both persistent vasomotor symptoms in combination with other cardiovascular risk factors could increase the risk of cardiovascular events.

Thus, lifestyle changes, such as smoking cessation, could reduce the overall risk for cardiac events associated with vasomotor symptoms and migraine.

Given the impact of vasomotor symptoms on women’s quality of life, the researchers examined the factors that predispose women to persistent vasomotor symptoms in the second study. Specifically, they examined factors that would predispose women to persistent vasomotor symptoms compared with infrequent symptoms.

The researchers found that Black adults as well as people who smoke, have less than high school education, or had symptoms of migraine or depression at baseline or who had received a hysterectomy at 15 years after enrollment had an increased risk of persistent vasomotor symptoms. Similarly, Black adults and people with lower body mass index at baseline were associated with increasing vasomotor symptoms with age.

The researchers then conducted further analysis by categorizing women based on whether they experienced persistent bothersome vasomotor symptoms or non-bothersome symptoms. Women who experienced bothersome symptoms shared risk factors similar to those experiencing persistent symptoms.

In addition to these shared risk factors, the researchers found an association between bothersome symptoms and thyroid disease. While further research is needed, these results suggest that screening for thyroid disease and its management could potentially reduce the risk of vasomotor symptoms later in life.

The two studies’ strengths included their prospective design, which involves tracking participants over a long period. Moreover, both studies accounted for several variables, including the use of hormone therapy and gynecological surgery, that could affect the analysis.

However, both studies were correlational and thus did not establish causation. The methods used for categorizing participants into groups based on the severity of their vasomotor symptoms also differed from those used in other studies. Thus, it is possible that using a different classification system for vasomotor symptoms could have yielded different results.

Lastly, the two studies used self-reports on migraine and vasomotor symptoms, making these data susceptible to bias.