From reproductive to midlife health: premenstrual disorders linked to cardiometabolic risks and vasomotor symptoms but not subclinical nor manifest CVD

Background/Introduction Women’s reproductive health history is increasingly recognized as a window into later cardiovascular risk. Premenstrual disorders (PMDs) affect up to one in five women and have recently been linked to hypertension, dyslipidemia, and early-onset atherosclerotic cardiovascular disease (ASCVD). Yet, whether PMDs signal increased atherosclerotic burden later in life remains unclear. It is also unclear whether PMDs predict bothersome climacteric vasomotor symptoms (VMS), which have been linked to subclinical and manifest ASCVD. Purpose The aim of the study was to assess associations between a history of PMDs and prevalence of subclinical and manifest atherosclerotic ASCVD in mid-life women. An additional objective was to compare the prevalence of cardiometabolic risk indicators as well as reported VMS between women with and without a history of PMDs. Methods This cross-sectional study included women aged 50-64, examined between 2015 and 2018, from two of the sites in the population-based multicenter Swedish CArdio-Pulmonary bio-Image Study (SCAPIS). Participants underwent coronary computed tomography angiography, carotid sonography, clinical physical examinations with blood sampling, and responded extensive questionnaires. Subclinical ASCVD was defined as (1) any coronary atherosclerosis, (2) coronary artery calcium score (CACS) >0, (3) segment involvement score >3, and (4) any carotid plaque. Manifest ASCVD was defined as either coronary heart disease or stroke as identified from the national patient register or questionnaires. History of PMDs and VMS were reported on a four-point severity scale and dichotomized: never/mild vs. moderate/severe. Associations were assessed using multivariable logistic regression, adjusting for age, socioeconomic, lifestyle, and clinical factors. Age-standardized comparisons were assessed using Tukey’s test. Results Out of 4,405 eligible participants, 23.3% reported a history of PMDs. After multiple adjustments, no association was observed between PMDs and either subclinical (n = 1,003) or manifest ASCVD (n = 189), odds ratio for any coronary atherosclerosis 0.91 (95 % confidence interval 0.71-1.18) and for manifest ASCVD, 1.12 (0.65-1.93). Following age standardization, women with a history of PMDs exhibited higher waist circumference (p=0.004) and higher prevalences of hypertension (p=0.006) and a history of VMS (p<0.001) relative to women without PMDs. For diabetes and hyperlipidemia there were no clear differences. Conclusion(s) In this population-based imaging cohort of midlife women, a history of PMDs was not associated with subclinical or manifest ASCVD. Nevertheless, women with PMDs showed a less favorable cardiometabolic profile and more frequent VMS, suggesting broader susceptibility to cardiometabolic and vasomotor dysregulation. Further studies should explore how PMDs relate to cardiometabolic risk development across the life course.