Is There A Connection Between Hot Flashes and Heart Disease In Menopause?

Have you wondered about the connection between hot flashes and heart disease? Hot flashes are a common symptom of late perimenopause and menopause. Hot flashes and night sweats are also known as vasomotor symptoms (VMS).

Vasomotor symptoms of menopause are often seen as an annoying but benign symptom of menopause that will go away with time.

Many women endure them without treatment, accepting them as a mere inconvenience that comes with aging. However, emerging research indicates that hot flashes are more than just a nuisance—they can potentially be a marker of the development of cardiovascular disease.

A meta-analysis study from 2020 suggests that persistent vasomotor symptoms (like night sweats and hot flashes) raise a woman's risk of developing cardiovascular diseases.

Read more or check out our video below.

What are Hot flashes?

Hot flashes (or hot flushes) are one of a number of perimenopausal symptoms. They are characterized by sudden feelings of warmth or intense heat and sweating especially in the face, neck and chest. They may also sometimes be accompanied by chills.

Your skin might turn red like you're blushing, and you might sweat a lot.

Night sweats are hot flashes that happen during sleep and can wake you up many times per night and for some women with wet sleepwear and sheets.

Hot flashes or vasomotor symptoms affect approximately 75% of menopausal women and typically hot flashes start in late perimenopause and last for an average of 7.5 years.

They are symptoms that originate in the hypothalamus, which is involved with temperature regulation. The fluctuating and declining estrogen levels experienced in perimenopause and menopause cause the temperature regulation capacity in the brain to become dysregulated.

Bothersome hot flashes can disrupt daily activities, disturb sleep, and significantly impact quality of life. These symptoms are more than skin-deep, and can signal underlying health issues.

Recent studies have shown a strong connection between the severity and frequency of vasomotor symptoms and the development of heart disease.

The incidence of heart disease increases dramatically in women after menopause. A woman's risk of a heart attack increases by 2.6 times once she has experienced menopause compared with women of the same age who are still premenopausal.

In fact, women who experience more frequent night sweats or more severe hot flashes are at a higher risk of cardiovascular events, such as heart attacks and strokes.

The Heart of the Matter

Cardiovascular disease is the leading cause of death among women, surpassing breast cancer.

Traditional cardiovascular risk factors like high blood pressure, diabetes, and obesity have long been recognized as contributing to the development of heart disease.

However, hot flashes are now emerging as a significant marker for heart health.

The physiological mechanisms behind this connection are still being explored, but several theories exist:

• Vascular Changes: Hot flashes may signal changes in the blood vessels, which could indicate early stages of cardiovascular disease.

• Inflammation: Chronic inflammation, often associated with hot flashes, can damage blood vessels and increase the risk of heart disease.

• Autonomic Dysfunction: The autonomic nervous system, which controls involuntary functions like heart rate and blood pressure, may be disrupted during hot flashes.

Hot Flashes Are Not Just a Heat Wave

A number of studies show that women who experience either a greater frequency of night sweats or greater severity of vasomotor symptoms experience the following changes in their cardiovascular system that predispose them to having a heart attack of stroke:

1. Increased thickening of the artery wall (increased intima media thickness). As the diameter of the artery increases, the space for blood flow through the vessel decreases.

2. Increased calcification of the aorta - which is an indication of the development of plaques in the artery wall.

3. Reduced flow-mediated dilation (FMD) of the brachial artery - a marker of dysfunction of the endothelial cells that line the artery. Healthy endothelial cells produce nitric oxide to dilate or widen the diameter of the artery (Hot Flashes & Sub-Clinical Heart Disease 2008).

The Role of Estrogen in Cardiovascular Health

Estrogen plays a crucial role in maintaining cardiovascular health. It helps keep blood vessels flexible, promotes healthy cholesterol levels, and has anti-inflammatory properties.

During perimenopause, the body's estrogen levels fluctuate and plummet, leading to various physiological changes that can negatively impact heart health.

1. Estrogen's Direct Cardio-Protective Effects

• Blood Vessel Health: Estrogen helps maintain the elasticity of blood vessels, allowing them to expand and contract easily. This flexibility is essential for regulating blood pressure and ensuring proper blood flow.

• Cholesterol Levels: Estrogen helps increase levels of high-density lipoprotein (HDL) cholesterol, often referred to as "good" cholesterol, while reducing low-density lipoprotein (LDL) cholesterol, or "bad" cholesterol.

• Anti-inflammatory Properties: Chronic inflammation is a significant risk factor for cardiovascular disease. Estrogen's anti-inflammatory effects help mitigate this risk.

2. Estrogen's Indirect Cardio-Protective Effects Via Metabolism

Estrogen also performs important roles in regulating metabolism including regulating:

• food intake

• fat distribution and burning

• energy storage and expenditure

• Glucose balance and insulin sensitivity.

As estrogen levels fall, they impact metabolism in ways that increase cardiometabolic risk includeing promotion of inflammation and visceral weight gain.

How to Treat Hot Flashes—A Protective Measure Against Heart Disease

Given the potential link between hot flashes and heart disease, managing hot flashes should not be viewed as a mere lifestyle choice or even as a weak option for those unwilling to endure their hot flashes. Instead, it should be considered a proactive step towards protecting cardiovascular health.

1. Hormone Replacement Therapy (HRT)

Hormone Replacement Therapy is one of the most effective treatments for hot flashes. By providing more steady estradiol hormone levels, HRT can alleviate symptoms and potentially reduce the risk of heart disease.

A number of studies have demonstrated cardioprotective effects of using HRT in perimenopause/early menopause:

• The estrogen-only arm of the Women's Health Initiative Study (WHI) demonstrated a reduced risk of heart disease in women who were aged younger than 60 when they commenced use of estrogen (WHI & HRT 2018).

• The Danish Osteoporosis Prevention Study (DOPS) demonstrated that when HRT is initiated up to 7 months after menopause, women had a reduced risk of dying from heart disease, less heart failure and heart attacks. This study also demonstrated no increase in blood clots, strokes, or cancer (Early HRT and heart disease 2012).

• The Early versus Late Intervention Trial (ELITE) demonstrated that women who started HRT within the first 6 years after menopause developed less thickening of the carotid artery than those who started it after 10 years since they experienced menopause.  This supports the timing hypothesis of HRT, which indicates that when HRT is commenced at perimenopause or menopause it reduces the  progression of atherosclerosis (Early vs Late Estradiol Treatment After Menopause 2016).

The date suggests that when HRT is initiated during early menopause it slows the development of cardiovascular disease and reduces the risk of heart attacks. It is crucial to consult with a healthcare provider to discuss the benefits and risks of HRT for you.

2. Non-Hormonal Treatments

For women who cannot or prefer not to use hormone therapy, several non-hormonal treatments are available, to reduce hot flashes and vasomotor symptoms:

1. Medications

Certain antidepressants such as selective serotonin reuptake inhibitors, blood pressure medications such as clonidine, and pain medications such as gabapentin are used to reduce hot flashes.

Additionally a new medication: Fezolinetant (a neurokinin 3 receptor antagonist) also reduces hot flashes. There is no documented benefit however that using these medications to reduce hot flashes has any benefit for improving cardiovascular health.

2. Lifestyle Medicine

There are a number of lifestyle changes you can make to reduce your cardiovascular risk. Some studies suggest that regular exercise reduces the frequency of hot flashes. It appears that exercise training can improve thermoregulatory control and reduces the frequency of hot flashes by 60 percent (Exercise Training Reduces Menopausal Hot Flushes 2016).

It is well recognised that a active lifestyle and Mediterranean diet as well as good stress management and social support reduces the risks of heart disease.

Additionally the inclusion of plant estrogens (phytoestrogens) in your diet, particularly soy isoflavones found in edamame, soymilk, tofu, tempeh and miso are associated with reduced heart attacks.

Those with the highest soy consumption had a 10 percent reduced mortality from all cause compared with those with the lowest soy consumption (Soy effects on cardiovascular disease 2019). To get the benefits of soy isoflavones in your diet it is recommended you eat 2 servings of soy per day.

3. Lifestyle Support

There is evidence that a regular yoga can reduce the frequency of hot flashes (Yoga and Hot Flashes 2014). Yoga is a great practice to help you feel strong and connected to your body and breath. You can practice yoga solo at home or in a group class setting.

Cognitive behavioral therapy (CBT) has also shown promise in reducing the frequency of hot flashes, improved sleep and general wellbeing. Although helpful at symptom control, there are no studies tracking yoga or CBT as reducing the long-term risk of heart disease.

The Takeaways: Hot Flashes & Menopause

Hot flashes are not just an uncomfortable part of menopause; they are an indicator of heart health, and increased frequency of night sweats and severity of hot flashes are associated with increased risk of heart disease.

Treating hot flashes should be regarded as an essential step in preventing cardiovascular disease, not just a way to improve quality of life or get rid of an annoying symptom.

Combining HRT with lifestyle medicine is a great way to support your cardiovascular health.

By recognizing and addressing the connection between hot flashes and heart disease, we can take proactive measures to protect women's health.

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Dr Deb Brunt @ Ōtepoti Integrative Health would love to support you explore the best options to treat your hot flashes and to reduce your cardiovascular risk.

Dr Deb Brunt is a women's health and menopause specialist in Dunedin, New Zealand and also provides health coaching internationally to support optimal health habits so you can live your best life.

Dr Deb Brunt | Ōtepoti Integrative Health | Book Appointment

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References

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