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Anxiety, depressive symptoms, and cardiac autonomic function in perimenopausal and postmenopausal women with hot flashes

a brief report

Fu, Polly, MD1; Gibson, Carolyn J., PhD, MPH1,2; Mendes, Wendy Berry, PhD3; Schembri, Michael, BS4; Huang, Alison J., MD, MAS, MPhil1

doi: 10.1097/GME.0000000000001153
Brief Report

Objective: The aim of the study was to examine whether anxiety and depressive symptoms are associated with an adverse cardiac autonomic profile among midlife women with hot flashes.

Methods: Anxiety and depressive symptoms were evaluated by validated self-administered questionnaires among peri- and postmenopausal women in a randomized trial of slow-paced respiration for hot flashes. Pre-ejection period (PEP), a marker of sympathetic activation, and respiratory sinus arrhythmia (RSA), a marker of parasympathetic activation, were measured at baseline and 12 weeks using impedance cardiography and electocardiography. Multivariable repeated measures linear regression models examined associations between anxiety and depression symptoms and autonomic markers, corrected for multiple comparisons with Benjamini–Hochberg procedure, and adjusted for age and body mass index.

Results: Among the 121 participants, greater state anxiety was associated with shorter PEP, reflecting higher sympathetic activity (β = −0.24, P = 0.02). Greater trait anxiety and cognitive anxiety were associated with lower RSA, reflecting decreased parasympathetic activity (β = −0.03, P < 0.01 for Spielberger Trait Anxiety; β = −0.06, P = 0.02 for Hospital Anxiety and Depression Scale [HADS] Anxiety Subscale). Greater depressive symptoms were associated with lower RSA (β = −0.06, P = 0.03 for HADS Depression Subscale; β = −0.03, P = 0.04 for Beck Depression Inventory).

Conclusions: Among peri- and postmenopausal women with hot flashes, greater self-reported anxiety and depressive symptoms were associated with lower levels of resting cardiac parasympathetic activity, and greater state anxiety was associated with higher levels of cardiac sympathetic activity. Findings suggest that midlife women with increased anxiety and depressive symptoms may have an unfavorable cardiac autonomic profile with potential implications for their overall cardiovascular risk.

1Department of Medicine, University of California, San Francisco, CA

2San Francisco Veterans Affairs Health Care System, San Francisco, CA

3Department of Psychiatry, University of California, San Francisco, CA

4Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA.

Address correspondence to: Alison J. Huang, MD, MAS, MPhil, UCSF General Internal Medicine, 1545 Divisadero Street, San Francisco, CA 94143-0320. E-mail:

Received 14 February, 2018

Revised 9 May, 2018

Accepted 9 May, 2018

Funding/support: This study was funded by grant #5R01AT005491 from the National Center for Complementary and Integrative Health (formerly the National Center for Complementary and Alternative Medicine). AJH was supported by a Paul B. Beeson Career Development Award in Aging Research from National Institute on Aging (1K23AG03833) and the American Federation on Aging Research. CJG was supported by an Advanced Fellowship in Women's Health from the Veteran's Affairs Office of Academic Affiliations.

Financial disclosure/conflicts of interest: AJH has received grants from Pfizer Inc. and Astellas Pharma through the University of California San Francisco to conduct research unrelated to this report.

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© 2018 by The North American Menopause Society.