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For middle-aged women plagued by migraines, or hot flashes and night sweats, another worry may linger in the back of their minds: whether these experiences have prepared them for a heart attack, stroke or other cardiovascular crisis.
After all, previous research suggesting such a link during and after menopause has received a lot of attention.
But a couple of new studies in the journal Menopause suggest that most of them don’t need to worry as much, especially if they don’t have migraines or prolonged hot flashes or night sweats.
Instead, they should focus on addressing other factors that may increase their cardiovascular risk by sleeping more, exercising and eating healthy foods, quitting tobacco, and watching their blood pressure, blood sugar, cholesterol, and weight.
For women who have experienced migraines and hot flashes or night sweats for many years, one of the new studies suggests an additional level of cardiovascular risk. That makes preventing heart disease and stroke even more important in this group, says study leader Catherine Kim, MD, MPH, of the University of Michigan.
And for women currently in their 20s and 30s who experience migraines, new research suggests they may be at higher risk of long-term menopause-related symptoms as they age.
Long-term study yields important insights
Kim and her colleagues at Michigan Medicine, U-M’s academic medical center, published the new pair of studies based on an in-depth analysis of data from a long-term study of more than 1,900 women who volunteered for undergo regular physical exams and blood tests. and conduct annual health surveys, from the late teens to early 30s.
Those women, now in their 50s and 60s, have given researchers invaluable insight into what factors shape health in the years before menopause and beyond, through their continued participation in the CARDIA study.
“The anxiety and fear that women with migraines and menopausal symptoms feel about cardiovascular risk are real, but these findings suggest that focusing on prevention and correcting unhealthy habits and risk factors could help most women.” “said Kim, associate professor of internal medicine at UM and a primary care physician.
“For the subgroup with migraines and early persistent hot flashes and night sweats, and for those currently experiencing migraines in early adulthood, these findings point to an additional need to manage risks and address symptoms early,” he adds.
Just over 30% of middle-aged women in the study reported having persistent hot flashes and night sweats, which together are called vasomotor symptoms or VMS because they are related to changes in the diameter of blood vessels.
Of those, 23% had reported also suffering from migraines. This was the only group in which Kim and her colleagues found an additional risk of stroke, heart attack or other cardiovascular events that could not be explained by other risk factors long known to be linked to cardiovascular problems. .
In addition to those with persistent vasomotor symptoms that began at age 40 or earlier, 43% of women in the study had minimal levels of such symptoms at age 50, and 27% experienced an increase in VMS over time until the 50s and early 60s.
The latter two groups did not have excess cardiovascular risk once their other risk factors were taken into account, whether they had migraines or not. The use of hormonal contraceptives and estrogens to address medical problems did not affect this risk.
Controlling destiny
Studying data from the same women early in life, researchers found that the most important factors in predicting who would suffer persistent hot flashes and night sweats were having migraines, depression, and smoking cigarettes, as well as being black or have less than secondary education.
“These two studies together underscore that not all women have the same experiences as they age, and that many can control risk factors that could increase their chances of heart disease and stroke later in life.” Kim said. “In other words, women can do a lot to control their destiny both when it comes to menopausal symptoms and cardiovascular disease.”
He notes that the American Heart Association calls these risk factors the “Essential 8” and offers guides on what women, men, and even children and teens can do to address them.
Evolving knowledge and treatment
The long-term study from which the two new findings come was designed specifically to look at cardiovascular risks when it was launched in the mid-1980s. CARDIA stands for Coronary Artery Risk Development in Young Adults.
In the 1980s, knowledge about the biology of blood vessels, down to the cellular and molecular level, was nowhere near what it is today. Both the vasomotor symptoms of menopause and migraines have to do with the contraction and dilation of blood vessels.
But decades of research have shown the microscopic impacts on blood vessels of years of smoking, poor sleep, poor eating habits and lack of activity, as well as a person’s genetic heritage, life experiences and hormonal history.
In recent years, new injectable migraine medications called calcitonin gene-related peptide (CGRP) antagonists have come to market.
Using monoclonal antibodies, they target a key receptor on the surface of blood vessel cells to prevent migraines and cluster headaches. But they are expensive and not covered by insurance for all people with migraines.
While the new study is based on data from years before these medications were available, Kim said he recommends them to his patients with persistent migraines, as well as working with them to understand what triggers their migraines and how to use other medications, including pain relievers. and anti-seizure medications to prevent seizures.
She also notes that the article about the future risk of persistent hot flashes and night sweats echoes the recent trend of using antidepressant medications to try to alleviate these effects of menopause.
Kim also says there has been growing evidence about the importance of healthy sleep habits in reducing hot flashes, as well as short-term use of estradiol-based hormone therapy patches, which have not been shown to have a link to risk. cardiovascular. And she points out that research has not shown any over-the-counter supplements or herbal remedies to be effective, and that they are much less regulated than medications.