Moderate To Severe Hot Flashes Linked To Higher Risk Of Heart Disease, Study Finds


According to new research presented at the 25th European Congress of Endocrinology in Istanbul on May 14, 2023, having severe hot flashes after menopause is associated with a higher risk of developing metabolic syndrome and high blood pressure later in life.

Metabolic syndrome and high blood pressure are said to be the top contributors to heart disease. Moreover, the Centers for Disease Control and Prevention says that this is the number one killer for women in the United States, responsible for 1 in every 5 female deaths.

Lead author, Elena Armeni, MD, PhD, a member of the faculty of medicine at National and Kapodistrian University of Athens in Greece says, “The findings highlight the importance of cardiovascular risk assessment and patient education.”

Dr. Armeni adds that women with severe hot flashes should be aware of the associated cardiovascular risks before they decide on the best or most appropriate treatment strategy for their menopause symptoms.


The Most Common Menopause Symptoms: Hot Flashes

Hot flashes, classified as a vasomotor symptom (VMS) of menopause, manifest as sudden surges of heat, often leaving the face and neck flushed and the body perspiring profusely. As per John Hopkins Medicine, these episodes or “bursts” of heat can vary in duration, lasting anywhere from 30 seconds to five minutes.

Notably, approximately three out of four women in the United States experience hot flashes during the menopausal transition, making it the most common symptom associated with this stage of life, as reported by the North American Menopause Society (NAMS).

Normally, women experience hot flashes anywhere between six months to two years, but in rare cases, they can last for up to 10 years. Sadly, they don’t automatically go away once a woman goes through menopause either. Some women tend to have recurrences of hot flashes for up to a decade after menopause.


Women With Severe Hot Flashes Linked to Higher Risk of Developing Metabolic Syndrome

The study involved 825 healthy women between the ages of 40 and 65 years old who recently went through menopause and didn’t have any signs of metabolic syndrome, nor were they taking hormone replacement therapy.

Metabolic syndrome is described as a group of conditions that, when experienced together, raise your risk of heart disease, stroke, diabetes, and other health issues, says the National Heart, Lung, and Blood Institute.

According to Johns Hopkins Medicine, people with three or more of the following symptoms may have metabolic syndrome:

  • A large waistline or excess fat at the waist, defined as more than 40 inches around the waist for men, and more than 35 inches for women
  • High blood pressure, defined as 130/85 millimeters of mercury (mmHg) or higher
  • High blood sugar, defined as fasting blood sugar levels of 100 milligrams per deciliter (mg/dL) or higher
  • High triglycerides, defined as more than 150 mg/dL
  • Low HDL (“good”) cholesterol, defined as less than 40 mg/dL for men or less than 50 mg/dL for women.

After an initial evaluation, participants were categorized into three groups: those without hot flashes, those with mild hot flashes, and those with moderate to severe hot flashes.

The severity of hot flashes was determined based on each individual’s subjective assessment using the standardized menopause evaluation tool, the Greene Climacteric scale. Those reporting “quite a bit” or “extremely” frequent hot flashes were classified into the moderate-to-severe category.

Over a 15-year monitoring period (from 2006 to 2021), researchers observed the development of metabolic syndrome, new-onset hypertension, and dyslipidemia (high cholesterol and triglyceride levels) in the participants.

Notably, individuals experiencing moderate to severe hot flashes were not only more likely to develop hypertension and metabolic syndrome but also tended to receive these diagnoses at an earlier stage compared to women with milder or no hot flashes.


Heart Disease Risk and Hot Flashes Have Been Connected Before

Director of the Mayo Clinic’s Center for Women’s Health in Jacksonville, Florida, and medical director for NAMS, Stephanie Faubion, MD, says that this study’s findings are part of the accumulating data that hot flashes may be a marker for women who are at higher cardiovascular risk in the future.

“We should be more proactive in identifying these women earlier to initiate preventive strategies,” she says.

Previous studies have also shown that there is a link between cardiovascular health risk and hot flashes, however, this association was never studied in women with varying degrees of symptoms on a bigger scale, explain the authors.

Dr. Faubion explains, “This study showed that those women with moderate to severe hot flashes were more likely to develop hypertension and metabolic syndrome. We know there is a link between the risk factors for heart disease and VMS, but we don’t know if there is some shared common mechanistic pathway linking the two.”

In addition, another unknown is whether hot flashes are what cause an increased risk for metabolic syndrome, or vice versa. However, she adds that this is less likely.


Can Hormone Therapy Help Reduce Risk of Metabolic Syndrome?

The study’s findings point out the importance of cardiovascular disease prevention strategies, which include the potential use of hormone replacement therapy. This, according to Dr. Armeni, should be implemented soon after menopause.

Dr. Armeni continues by saying that regardless of the guidelines of many national and international societies that specify that the use of hormone therapy should only be for those with moderate-to-severe hot flashes. Meanwhile, the women who participated in this study weren’t being treated, and many went on to develop metabolic syndrome.

Regardless, the benefits and risks of hormone therapy still need to be considered on a case-to-case basis as it’s not appropriate for everyone, she shares.

“From prior studies, hormone therapy appears to have a beneficial effect on the components of metabolic syndrome, including lean body mass, abdominal fat, and waist circumference. All of this contributes to a lower risk of diabetes,” says Dr. Faubion.

Still, she adds that more research is needed to better understand whether the treatment of hot flashes with hormones may reduce the risk of hypertension and heart disease in the future.