SAN DIEGO — Early-onset and frequent hot flashes and night sweats in women were associated with poorer endothelial function, two observational studies showed.

Using menopausal vasomotor symptoms as a marker for adverse changes in vasculature may point to particular subgroups of women who would benefit from targeted cardiovascular prevention strategies,Rebecca Thurston, PhD, an associate professor in the department of psychiatry at the University of Pittsburgh, and colleagues reported.

Identifying women early in midlife with increased risk for developing cardiovascular disease would be helpful for primary prevention, Thurston said at a press briefing that preceded the American College of Cardiology meeting to be held here next week.

Traditional cardiovascular risk algorithms such as the Framingham risk score don’t tend to predict as well for the group Thurston studied: women early in midlife with intermediate risk of developing cardiovascular disease, she said.

But it may be early to incorporate findings into clinical practice, Thurston said. “We’re starting to tease out whether there is an association here and among whom.”

Physicians are beginning to look at vasodilation responses as preclinical indicators for cardiovascular disease, added moderator Richard Chazal, MD, vice president of the ACC and director of the Heart and Vascular Institute of Florida’s Lee Memorial Health System.

But how to incorporate data on vasomotor symptoms is not yet defined, he agreed.

The first study, the Women’s Ischemia Syndrome Evaluation Study (WISE), included 104 women with signs or symptoms of ischemia. They were over age 50 (mean age 67±8 years), postmenopausal, did not use hormones, and had their ovaries. Women gave detailed histories of their previous or current vasomotor symptoms.

Endothelial function was assessed via brachial artery flow mediated dilation (FMD), a marker that has been linked to clinical cardiovascular outcomes. Subjects underwent a brachial artery ultrasound to determine FMD.

Results were controlled for age, race, hormone use history, and obstructive coronary artery disease.

Women whose vasomotor symptoms began at age 42 or younger had a significantly lower FMD compared with women whose symptoms started after age 42 (P=0.038) and those who never had vasomotor symptoms.

The second study, MsHeart, included 189 women from ages 40 to 60 without cardiovascular disease. They were nonsmokers; had their uterus and ovaries; and were not using hormones, beta blockers, calcium channel blockers, insulin, or serotonin reuptake inhibitors.

Subjects wore monitors for 24 hours that measured their number of hot flashes. They also underwent brachial artery ultrasound to assess FMD.

Findings were adjusted for baseline lumen diameter, age, race, body mass index, menopausal stage, and prior hormone use.

The relationship between hot flashes and FMD varied significantly by age (P=0.03).

Among women 52 years or younger, a greater number of hot flashes was associated with lower FMD (P=0.02). There were no significant relationships between hot flashes and FMD in women older than 52.

“Very frequent, very early-onset vasomotor symptoms are giving us some information,” Thurston said. “Then we’d use our standard cardiovascular risk techniques … or even just point to those women who need a more rigorous workup. We might not typically do that for women in their 40s.”