Endocrine Abstracts

Introduction: A growing body of evidence supports the possible association between the severity of climacteric symptoms and long-term cardiometabolic risk. We aimed to assess the possible link between the severity of hot flashes and the risk for cardiometabolic manifestations after the menopausal transition.

Methods: This cohort study was conducted in the Menopause Clinic, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece. We reviewed outpatient records corresponding to 6,250 women, with no evidence of metabolic syndrome (MetSyn) at baseline and who were not on treatment with menopause hormone therapy (MHT) or selective estrogen modulators. Women should have had at least two full consultations 12 months apart. The eligible cases were matched one-two-one for age and the severity of hot flashes at baseline. We selected 825 women, stratified into three groups (no hot flashes vs mild vs moderate-to-severe). All participants were monitored for 15 years after their first visit (FU) for the development of MetSyn, new onset hypertension, and dyslipidemia.

Results: At the time of the first assessment, there was no association between the severity of hot flashes and the prevalence of hypertension and dyslipidemia (no vs mild vs moderate/severe: hypertension, 14.9% vs 20.9% vs 20.7%; dyslipidemia 8.4% vs 10.5% vs 6.9%). Women who experience severe symptoms at baseline had a higher prevalence of MetSyn and hypertension at 15-year follow-up (no vs mild vs moderate/severe, MetSyn 22.6% vs 17.1% vs 28.2%, P=0.049; hypertension, 26.9% vs 32.9% vs 38.9%, P=0.025). The time-to-diagnosis of MetSyn or hypertension was lower in women with more severe symptoms at baseline (KM curve, moderate/severe vs mild vs no, MetSyn 11.4±0.4 yrs vs 12.9±0.3 yrs vs 13.1±0.2 yrs; hypertension, 10.5±0.4 yrs vs 11.5±0.3 yrs vs 12.7±0.2 yrs; log-rank P<0.001 both cases). Cox-regression analysis showed that diagnosis of MetSyn was associated with moderate/severe hot flashes (HR=1.797, P=0.021), moderate alcohol consumption (HR=0.5, P=0.003), LDL-cholesterol (HR=1.007, P=0.016), intense exercise (HR=2.105, P=0.048), BMI (HR=1.095, P=0.025), age (HR=0.889, P<0.001). The diagnosis of hypertension was associated with moderate/severe hot flashes (HR=1.902, P=0.004), intense exercise (HR=2.276, P=0.008), current smoking (HR=1.664, P=0.008), moderate alcohol intake (HR=0.439, P<0.001), SBP (HR=1.029, P<0.001), BMI (HR=1.1, P=0.007), age (HR=0.888, P<0.001). The models were also adjusted for waist circumference, HOMA-IR, lipids, DBP.

Conclusions: Moderate-to-severe hot flashes were associated with incident risk for MetSyn and new-onset hypertension in young postmenopausal women. These observations bear implications for the use of MHT in women shortly after the menopausal transition.