Hot Flashes, Migraine Tied to Higher Risk of Stroke, Heart Disease

History of migraine combined with persistent hot flashes was associated with higher risks for cardiovascular disease and stroke, according to an analysis of women in the Coronary Artery Risk Development in Young Adults (CARDIA) study.

After adjusting for age, race, estrogen use, oophorectomy, and hysterectomy, women with both had more than a two-fold higher risk for cardiovascular disease compared with women without migraines and with minimal or increasing hot flashes (HR 2.25, 95% CI 1.15-4.38), reported Catherine Kim, MD, MPH, of the University of Michigan in Ann Arbor, and colleagues.

In addition, these women had more than a three-fold higher risk for stroke (HR 3.15, 95% CI 1.35-7.34), the group noted in Menopause.

However, after further adjusting for cardiovascular disease risk factors, including adequate control of blood pressure and cholesterol, these associations were attenuated for both cardiovascular disease risk (HR 1.51, 95% CI 0.73-3.10) and stroke risk (HR 1.70, 95% CI 0.66-4.38).

“This is good news,” Kim told MedPage Today.

These findings weren’t particularly surprising, she added, as women with migraine are commonly told that they are at increased risk for stroke and cardiovascular disease. Of note, Kim pointed out that the study showed that there was no increased cardiovascular or stroke risks for women who had just one of these conditions. But as women enter middle age, the combination of migraine history plus hot flashes may represent early indications of abnormal cardiovascular risk factor profiles.

Stephanie Faubion, MD, MBA, director of the Mayo Clinic Center for Women’s Health in Jacksonville, Florida, also noted that she wasn’t particularly surprised by these findings, pointing to prior studies that showed the links between hot flashes, migraines, and cardiovascular disease.

Faubion, who is also medical director of the Menopause Society, told MedPage Today that “we need to do a better job of figuring out how to weigh these female-specific or female-predominant risk factors for cardiovascular disease to be able to better predict which women will experience adverse outcomes later. This is important so that we can intensify efforts on prevention for these high-risk women.”

“We also need to refine our cardiovascular risk assessment models in women, particularly given that heart disease remains the number one killer of women,” she added.

For this analysis, Kim’s group included 1,954 women with 15-year follow-up data in the CARDIA study. Mean age was 40-41.

Of these women, 835 had minimal vasomotor symptoms, 521 had increasing vasomotor symptoms, and 598 had persistent vasomotor symptoms. There were 81 incident cardiovascular disease events, including 42 strokes.

Prevalence of migraine was higher in women with persistent vasomotor symptoms — 23% compared with 14% of those with minimal and 14% of those with increasing hot flashes.

Compared with women who had minimal vasomotor symptoms around age 40, those who self-reported persistent symptoms were more likely to be Black, have less than a high school education, and currently smoke cigarettes. Women with persistent vasomotor symptoms were less likely to use oral contraceptive pills, but more likely to use exogenous hormone therapies, report perimenopausal symptoms, and have histories of hysterectomy or oophorectomy.

In a sensitivity analysis, Kim’s group found no significant interaction when accounting for exogenous estrogen or oral contraceptive use at the 15-year follow-up mark.