Introduction:
Vasomotor symptoms (VMS) are common menopausal symptoms and the timing of these symptoms, specifically onset of late VMS, has recently been linked with cardiovascular risk factors. Chronic kidney disease (CKD) affects 13% of all women in the US and carries high risk for cardiovascular disease (CVD). The association between CKD and VMS has not been studied.
Hypothesis:
We hypothesized that the timing of VMS would differ between women with CKD compared to women without CKD. We also hypothesized that CKD would modify the effect of VMS on all-cause mortality, coronary heart disease and stroke.
Methods:
We studied the Women’s Health Initiative (WHI) biomarker cohort, which is comprised of all black and Hispanic participants in the WHI observation study and clinical trials plus a subset of white WHI participants such that the biomarker cohort reflects the age distribution of the HT population. CKD was defined as estimated glomerular filtration rate <60 mL/min/1.73m
2
and VMS was defined as self-report of hot flushes and night sweats. We used polytomous logistic regression to determine the cross-sectional associations (unadjusted, demographics-adjusted and multivariable-adjusted between CKD and reported VMS categories (none, early, late, persistent). We used Cox proportional hazards models with an interaction term to determine whether the association between late VMS and all-cause mortality or incident CVD was modified by CKD.
Results:
Among the 18,024 WHI participants, 1281 women (5.86%) had CKD. VMS were less common in women with CKD versus without CKD (37.6%
vs
45.8%, p<0.001). Prevalent CKD was associated with an OR of 0.85 (95% CI: 0.72, 1.00) for early VMS, OR 0.80 (95% CI: 0.66, 0.97) for late VMS, and OR 0.59 (95% CI: 0.50, 0.70) for persistent VMS, as compared to having no VMS. The overall association of CKD was not significant after adjusting for potential confounders (p=0.17). CKD was associated with increased risk for mortality (HR 1.72, 95% CI: 1.52, 1.95), coronary heart disease (HR 1.60, 95% CI: 1.33, 1.92) and stroke (HR 1.49, 95% CI: 1.18, 1.87). Late VMS were associated with increased all-cause mortality (HR 1.16, 95%CI 1.04, 1.30) but not significantly associated with coronary heart disease or stroke. No significant interactions were found between late VMS and CKD on any of the endpoints studied.
Conclusions:
In this multiethnic cohort, VMS were less common in women with CKD and CKD did not appear to modify the association between VMS and either incident CVD or total mortality.
Letter by Pyrogianni and La Vecchia Regarding Article, “Artificially Sweetened Beverages and Stroke, Coronary Heart Disease, and All-Cause Mortality in the Women’s Health Initiative”