Heart disease remains the leading cause of death in women. A study of 138 menopausal women examined the association of mood, symptoms, and quality of life measures with the key markers of vascular aging, a major risk factor for the development of cardiovascular disease (CVD). Study results were published in Menopause, the journal of The North American Menopause Society (NAMS).
It's no secret that the menopause transition is marked with a number of adverse health effects, including hot flushes and depression to vascular aging, which is typically seen as artery stiffening and endothelial dysfunction. With these problems all occurring around the same time in a woman's life, the authors of this latest study sought to determine whether menopause symptoms and depression are related to CVD.
The results, as reported in the article "Vascular dysfunction across the stages of the menopausal transition is associated with menopausal symptoms and quality of life," confirmed that. Across the stages of menopause, arterial stiffening and vascular dysfunction were associated with more frequent and severe menopause symptoms and a lower quality of life. No association, however, was found with depressive symptoms.
Previous studies have shown an especially strong link between hot flushes and increased cardiovascular risk and mortality. In this study, the frequency, but not severity, of hot flashes was specifically associated with greater arterial stiffening and reduced endothelial function.
The menopausal transition is associated with somatic symptoms and increased rates of depression, which can impair quality of life (QOL) and increase cardiovascular disease (CVD) risk. This period is also associated with accelerated vascular aging (arterial stiffening and endothelial dysfunction), an antecedent to CVD. This secondary analysis sought to explore associations between depression, menopausal symptoms and QOL, and vascular aging across menopause stages.
Arterial stiffness (carotid artery compliance), endothelial function (brachial artery flow-mediated dilation [FMD]), menopausal symptoms (Menopausal Symptom List [MSL]), depression (Center for Epidemiologic Studies Depression Scale [CES-D]), and QOL (Utian QOL Scale [UQOL]) were measured in 138 women (19-70 years) classified as premenopausal (n = 41, 34 ± 8 years; mean ± SD), early (n = 25, 49 ± 3 years), or late perimenopausal (n = 26, 50 ± 4 years), or early (n = 22, 55 ± 4 years) or late postmenopausal (n = 24, 61 ± 5 years). Differences across menopause stages were determined using one-way analysis of variance; associations between vascular measures and MSL, CES-D, and UQOL were tested using Pearson's correlation analyses.
Menopausal symptoms, depression, and QOL worsened across menopause stages, particularly in late perimenopausal women. Vasosomatic symptom frequency, and general somatic symptom frequency and severity were inversely correlated with carotid artery compliance and FMD (r = -0.27 to -0.18, all P < 0.05). Only correlations with general somatic symptoms were significant after adjusting for multiple comparisons. Total QOL was positively correlated with carotid artery compliance (r = 0.23, P = 0.01). CES-D scores were not correlated with carotid artery compliance or FMD (r = -0.08, -0.03, P = 0.35).
Vascular dysfunction across the stages of menopause was associated with greater frequency and severity of menopausal symptoms, and lower QOL, but not depression. Mechanisms underlying these associations (eg, inflammation, oxidative stress) should be explored.
Hildreth KL, Ozemek C, Kohrt WM1, Blatchford PJ, Moreau KL1. Vascular dysfunction across the stages of the menopausal transition is associated with menopausal symptoms and quality of life. Menopause. 2018 Apr 9. doi: 10.1097/GME.0000000000001112. [Epub ahead of print]