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Summary

Recently Li et al [1] published data of 675 mid-aged urban community living Chinese women. They aimed at determining associations between vasomotor symptoms (VMS; including hot flashes and sweats) and the metabolic syndrome (MetS; defined with Joint Interim Statement Criteria). In addition, serum levels of lipids, sex steroids, glucose were measured and blood pressure and anthropometric indices registered. After adjusting for several confounders (i.e age, menopausal status, sex steroid levels and physical activity) the authors found that hot flashes were independently associated with an almost two fold increased risk of the MetS (OR 1.98, 95% CI: 1.21-3.24, p = 0.006). Hot flashes and sweats were also independently associated with waist circumference and triglycerides. Nevertheless, they did find a significant relationship with blood pressure, glucose, HDL-C, and LDL-C levels. The authors concluded that women with hot flashes had a higher risk of presenting the MetS, with VMS being related to abdominal obesity and high triglyceride levels.

Commentary

During the menopausal transition women tend to significantly gain weight, in part due to the progressive decline of estrogen levels, to aging per se, and also to changes in lifestyles [2].  There is an increase in the percentage of total body fat and a shift in fat distribution from gynecoid to android causing the MetS [2]. The MetS increases cardiovascular risk through a status of chronic low grade inflammation caused mainly by fat adipocytokine overproduction. In parallel to this, and depending of the studied population, women report VMS as the main complaint which can severely impair female quality of life [3]. VMS have also been linked to cardiovascular risk and metabolic problems [4,5]. The association between VMS and the MetS found in the present study, implicating increased cardiovascular risk, has been reported previously and basically related to the fact that both, VMS and the MetS, share common sympathetic overactivity [5,6]. The authors also found a positive association between VMS and waist circumference and higher triglyceride levels [1]. The present study is interesting because aside from Korean women [5], data addressing these associations among Chinese mid-aged has not been reported. Analysis for the study was achieved thanks to The Peking Union Medical College Hospital Aging Longitudinal Cohort of Women in Midlife (PALM study), a study of midlife Chinese women transitioning through the menopause [7]. The mechanism underlying the link between VMS and dyslipidemia is not clear; however functional changes of the hypothalamic–pituitary–adrenal axis exerted over VMS and the regulation of increased fat-dependent adipokines on both VMS and lipid profiles could be the case [8].

The authors report the limitations of the study including the fact that women were recruited from one community by convenience, situation that limits the generalization of their results to other areas of China. Also, although cross-sectional studies provide good information, with this research design causal relationship cannot be ascertained. Despite these limitations, their study is the first to analyze and find a positive between VMS and the MetS among mid-aged Chinese women. The authors suggest that VMS may be considered a warning sign of metabolic problems and that metabolic dysfunction may play a role in the presentation of VMS. Under this scenario, women going through the menopausal transition should be encouraged to engage in changes of lifestyles, mainly increasing physical activity, healthy dieting, banning bad habits (i.e. smoking and alcohol consumption), all as cost effective ways to counter act against an increase of cardiovascular risk.

Peter Chedraui, MD, PhD
Instituto de Investigación e Innovación en Salud Integral
Universidad Católica de Santiago de Guayaquil, Guayaquil Ecuador

References

  1. Li J, Liu B, Tang R, et al. Relationship between vasomotor symptoms and metabolic syndrome in Chinese middle-aged women. Climacteric. 2021;24(2):151-156.
    https://pubmed.ncbi.nlm.nih.gov/33103941/
  2. Chedraui P. Reducing mid-life cardiovascular disease by improving reproductive health. Climacteric. 2018;21(6):519-520.
    https://pubmed.ncbi.nlm.nih.gov/30793633/
  3. Blümel JE, Chedraui P, Baron G, et al; Collaborative Group for Research of the Climacteric in Latin America (REDLINC). A large multinational study of vasomotor symptom prevalence, duration, and impact on quality of life in middle-aged women. Menopause. 2011;18(7):778-85.
    https://pubmed.ncbi.nlm.nih.gov/21407137/
  4. Thurston RC, Sutton-Tyrrell K, Everson-Rose SA, Hess R, Matthews KA. Hot flashes and subclinical cardiovascular disease: findings from the Study of Women’s Health Across the Nation Heart Study. Circulation. 2008;118(12):1234-40.
    https://pubmed.ncbi.nlm.nih.gov/18765392/
  5. Ryu KJ, Park HT, Kwon DH, Yang KS, Kim YJ, Yi KW, Shin JH, Hur JY, Kim T. Vasomotor symptoms and metabolic syndrome in Korean postmenopausal women. Menopause. 2015;22(11):1239-45.
    https://pubmed.ncbi.nlm.nih.gov/25899005/
  6. Freedman RR. Menopausal hot flashes: mechanisms, endocrinology, treatment. J Steroid Biochem Mol Biol. 2014;142:115-20.
    https://pubmed.ncbi.nlm.nih.gov/24012626/
  7. Sun X, Luo M, Ma M, et al. Ovarian aging: an ongoing prospective community-based cohort study in middle-aged Chinese women. Climacteric. 2018;21(4):404-410.
    https://pubmed.ncbi.nlm.nih.gov/29741107/
  8. Karastergiou K, Mohamed-Ali V. The autocrine and paracrine roles of adipokines. Mol Cell Endocrinol. 2010;318(1-2):69-78.
    https://pubmed.ncbi.nlm.nih.gov/19948207/
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