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Hot flashes and cardiac vagal control: a link to cardiovascular risk?

Thurston, Rebecca C. PhD1,2; Christie, Israel C. PhD1; Matthews, Karen A. PhD1,2

doi: 10.1097/gme.0b013e3181c7dea7

Objective: The understanding of the physiology of hot flashes is incomplete. The autonomic nervous system has been hypothesized to play a role in hot flashes but has received limited empirical attention. Furthermore, emerging research has linked hot flashes to cardiovascular risk. Reduced high-frequency heart rate variability (HF-HRV), an index of vagal control of heart rate, has been associated with cardiovascular events. We hypothesized that decreases in HF-HRV would occur during hot flashes relative to periods before and after hot flashes.

Methods: Thirty perimenopausal and postmenopausal women aged 40 to 60 years reporting four or more hot flashes per day underwent laboratory hot flash provocation testing, with electrocardiogram and measurement of sternal skin conductance. Hot flashes were reported and identified from sternal skin conductance. HF-HRV was estimated using spectral analysis of the heart rate time series. The 5-minute interval during the hot flash period was compared with that during two nonflash periods before and after the hot flash via mixed-effects models.

Results: HRV was significantly decreased during hot flashes relative to periods before (b = 0.18, SE = 0.05; P = 0.0001) and after (b = 0.16, SE = 0.05; P = 0.002) physiologically measured hot flashes, controlling for age, race, education, task condition, menopause status, task, hypertension status, diabetes status, physical activity, body mass index, smoking, and anxiety. Findings were unchanged when considering self-reported hot flashes.

Conclusions: Significant decreases in cardiac vagal control occurred during hot flashes, which may help shed light on the physiology of hot flashes. The autonomic nervous system may deserve greater attention in understanding the mechanisms linking hot flashes to cardiovascular risk.

Findings from this laboratory investigation indicated acute reductions in high-frequency heart rate variability during physiologically assessed hot flashes. These findings shed additional light on the physiology of hot flashes, suggesting a role for vagal control in hot flashes.

From the 1Department of Psychiatry, School of Medicine, and 2Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.

Received August 17, 2009; revised and accepted October 22, 2009.

Funding/support: This study was supported by The Fannie E. Rippel Foundation/American Federation Research New Investigator Award on Gender Differences in Aging (principal investigator: Dr. Thurston), the Pittsburgh Mind-Body Center (National Institutes of Health grants HL076852/076858).

Financial disclosure/conflicts of interest: None reported.

Address correspondence to: Rebecca C. Thurston, PhD, 3811 O'Hara St., Pittsburgh, PA 15213. E-mail:

©2010The North American Menopause Society