Menopausal Symptoms Tied to Cardiovascular Risk

A new analysis of data from the Women’s Health Initiative CaD (Calcium and Vitamin D) trial showed that women with greater menopausal symptoms faced higher risk of cardiovascular illness, researchers said.

Women who had two or more moderate to severe menopausal symptoms had higher rates of stroke (hazard ratio 1.40, 95% CI 1.04-1.89) and cardiovascular disease (HR 1.35, 95% CI 1.18-1.54), reported Matthew Nudy, MD, of the Penn State Hershey Medical Center, and colleagues.

Moreover, calcium and vitamin D supplements did not mitigate risk of adverse health outcomes in this population, Nudy said in a presentation at the North American Menopause Society 2020 virtual meeting.

“More moderate or severe menopausal symptoms were associated with more cardiovascular disease and stroke,” Nudy said in the presentation. He added that it is unknown whether treating cardiovascular disease will reduce menopausal symptoms or vice versa.

Angelina Gangestad, MD, ob/gyn division chief at University Hospitals Cleveland Medical Center, told MedPage Today that it was novel that “the patients that had the highest number of menopausal symptoms also had the highest risk of cardiovascular disease.”

But Gangestad, who was not involved in the study, cautioned that no causal link can be inferred from the association between menopausal symptoms and adverse health outcomes. The findings represent an opportunity for further research about cardiovascular risk in women who tend to feel more severe menopausal symptoms, she said.

Judi Chervenak, MD, of Montefiore Medical Center in New York City, said “it was interesting that supplementation and vitamin D had no influence on these findings.” Calcium and vitamin D are critical for bone health in postmenopausal women, but Chervenak added that large doses aren’t necessarily safe.

In this trial, Nudy and colleagues assessed whether the severity of vasomotor symptoms and the number of menopausal symptoms had health risks, as well as whether calcium and vitamin D had any effects.

Researchers analyzed data from more than 20,000 participants in the calcium and vitamin D supplementation arm of the Women’s Health Initiative, a double-blind, randomized, placebo-controlled study of postmenopausal women between 50 and 79 years old. Study participants were followed up for about 7 years.

Menopausal symptoms tracked in the study included hot flashes, night sweats, dizziness, heart palpitations, tremors, restlessness or fatigue, difficulty concentrating, forgetfulness, vaginal dryness, breast tenderness, and headache or migraine. Health outcomes included hip fracture, colorectal cancer, invasive breast cancer, all-cause mortality, coronary heart disease, stroke, cardiovascular death, and total cardiovascular disease.

Mean participant age was 63. Those with at least two moderate to severe symptoms were more likely to have had a hysterectomy or an oophorectomy, and also had a greater chance of having hypertension, hyperlipidemia, diabetes, and cardiovascular disease.

Severity of vasomotor symptoms had no association with any adverse health outcome. However, Nudy and colleagues found that presence of dizziness, heart racing or skipping beats, restlessness, fatigue, difficulty concentrating, forgetfulness, and headaches were all associated with risk of total cardiovascular disease.

  • Amanda D’Ambrosio is a reporter on MedPage Today’s enterprise & investigative team. She covers obstetrics-gynecology and other clinical news, and writes features about the U.S. healthcare system. Follow


This research was funded by the National Heart, Lung & Blood Institute, the National Institutes of Health, and the U.S. Department of Health and Human Services.

Nudy and colleagues disclosed no conflicts of interest.

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