Vasomotor symptoms and cardiovascular disease risk

Although the exact etiology of hot flushes and night sweats has not been fully clarified, the intriguing question whether vasomotor symptoms (VMS) are markers of coronary artery disease risk has been evaluated in several studies. Surrogate metabolic and hemodynamic parameters point at adverse alterations in flushers, but the results related to clinical endpoints are not unidirectional. Recent relevant data come from the Women's Health Initiative (WHI) observational study (60 000 women, mean age 63 years, mean follow-up period 10 years). Women with VMS only at onset of menopause but not at enrollment to the WHI study had a modest, yet significant decreased risk of stroke, total cardiovascular disease events, and all-cause mortality, compared with women having no VMS. Contrarily, women with late VMS (reported at enrollment to the study but not at onset of menopause) had an increased risk in the above-mentioned parameters. There was no interaction between hormone use and VMS in this respect. This mini-review, which summarizes the relevant data, shows that hot flushes seem to be a marker for physiological alterations that could be associated with cardiovascular disease.