Hot Flashes and their Association with Carotid Intima Media Thickness in Midlife and Beyond

Recent evidence suggests that there is an association between menopausal hot flashes and cardiovascular risk. Higher Carotid Intima Media thickness (CIMT) associated with subclinical atherosclerosis Subclinical atherosclerosis is predictive of later coronary vascular disease. To study the association of hot flashes in perimenopause and postmenpause women with carotid intima media thickness. Cross sectional prospective observational study was conducted among women aged 40-55 at Saveetha Medical College Gynecology Department. After ethical clearance and informed consent was obtained, 120 participants were recruited. Perimenopause and menopause women with intact uterus with both ovaries were included. Exclusion criteria were, chronic medical diseases, cancer women on long term medication, and use of hormonal/hormone-like supplements. After routine examination, anthropometric measurement, fasting blood sample for serum estradiol on 2-5 days of a spontaneous menstrual cycle was taken. CIMT of left and right carotid artery at four locations was assessed with B mode USG Philips affinity 30 with 4-12mhz frequency transducer. To assess hot flashes, a questionnaire was given. Women were divided into one of three groups according to hot-flash status over the past three months, namely mild, moderate, and severe. Statistical analysis was done to correlate hot flashes with CIMT. Average age of women screened was 50.7 years. Perimenopausal women were 42.5%, 32.5% early post-menopausal women and 25% late postmenopausal women. Mild hot flash in 55.8%, moderate in 25.8% and severe in18.33% Mean CIMT in mild hot flash group 0.61mm +-0.08, in moderate hot flash group 0.63+-0.11 and in severe hot flash group 0.67+-0.12 mm with p value of 0.001 Seventy-five percentage of women who had severe hot flash were among BMI >30 and in 31.4% among perimenopause women. There is a positive correlation with severe hot flushers in obese and in perimenopausal women. The present study suggest that severe hot flashes are associated with increased CIMT in perimenopause and obese women. This findings may be a useful marker to provide risk stratification and can guide clinical care.