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Physiologically assessed hot flashes and endothelial function among midlife women

Thurston, Rebecca C. PhD1,2; Chang, Yuefang PhD3; Barinas-Mitchell, Emma PhD2; Jennings, J. Richard PhD1; von Känel, Roland MD5; Landsittel, Doug P. PhD4; Matthews, Karen A. PhD1,2

doi: 10.1097/GME.0000000000000857
Original Articles

Objective: Hot flashes are experienced by most midlife women. Emerging data indicate that they may be associated with endothelial dysfunction. No studies have tested whether hot flashes are associated with endothelial function using physiologic measures of hot flashes. We tested whether physiologically assessed hot flashes were associated with poorer endothelial function. We also considered whether age modified associations.

Methods: Two hundred seventy-two nonsmoking women reporting either daily hot flashes or no hot flashes, aged 40 to 60 years, and free of clinical cardiovascular disease, underwent ambulatory physiologic hot flash and diary hot flash monitoring; a blood draw; and ultrasound measurement of brachial artery flow-mediated dilation to assess endothelial function. Associations between hot flashes and flow-mediated dilation were tested in linear regression models controlling for lumen diameter, demographics, cardiovascular disease risk factors, and estradiol.

Results: In multivariable models incorporating cardiovascular disease risk factors, significant interactions by age (P < 0.05) indicated that among the younger tertile of women in the sample (age 40-53 years), the presence of hot flashes (beta [standard error] = −2.07 [0.79], P = 0.01), and more frequent physiologic hot flashes (for each hot flash: beta [standard error] = −0.10 [0.05], P = 0.03, multivariable) were associated with lower flow-mediated dilation. Associations were not accounted for by estradiol. Associations were not observed among the older women (age 54-60 years) or for self-reported hot flash frequency, severity, or bother. Among the younger women, hot flashes explained more variance in flow-mediated dilation than standard cardiovascular disease risk factors or estradiol.

Conclusions: Among younger midlife women, frequent hot flashes were associated with poorer endothelial function and may provide information about women's vascular status beyond cardiovascular disease risk factors and estradiol.

1Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA

2Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA

3Department of Neurosurgery

4Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA

5Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland.

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

Received 21 September, 2016

Revised 5 January, 2017

Accepted 5 January, 2017

Funding/support: This work was supported by the National Institutes of Health, National Heart Lung and Blood Institute (R01HL105647 and K24123565 to Thurston) and by the University of Pittsburgh Clinical and Translational Science Institute (NIH Grant UL1TR000005). The National Institutes of Health funded this work and approved the initial study design, but was not involved in the conduct of the study; collection, management, analysis, or interpretation of the data; nor the preparation, review, or approval of the manuscript.

Financial disclosure/conflicts of interest: None reported.

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© 2017 by The North American Menopause Society.