Prospective early adulthood risk factors for vasomotor symptoms in the Coronary Artery Risk Development in Young Adults study

This prospective examination of risk factors for vasomotor symptoms (VMS) beginning in early adulthood found that risk factors for VMS could be identified while women were in their 20s and were not entirely explained by risk factor levels later in life. Objective Previous studies have assessed potential risk factors for vasomotor symptoms (VMS) beginning in midlife. We examined whether early adulthood risk factors predict VMS trajectories over time.We performed a secondary data analysis of the Coronary Artery Risk Development in Young Adults (CARDIA) study, a population-based cohort. We included women who answered questions about VMS at three or more examinations (n = 1,966). We examined whether risk factors at baseline (when participants were aged 18-30 y; average age, 25 y) and the year 15 (Y15) exam (at ages 33-45 y; average age, 40 y) were associated with VMS trajectories from Y15 through Y35. Logistic regression models were used to evaluate the associations with VMS trajectories.We identified three trajectories of VMS presence: minimal (40%), increasing over time (27%), and persistent (33%). Baseline factors associated with persistent VMS over time included Black race, less than a high school education, depressive symptoms, migraines, cigarette use, and at Y15 hysterectomy. Baseline factors associated with increasing VMS over time included Black race and lower body mass index. Risk factors for bothersome VMS were similar and also included thyroid disease, although thyroid disease was not associated with persistence of VMS over time. Associations were similar among women who had not undergone hysterectomy and in Black and White women.Risk factors for VMS may be identified in early adulthood. Further examination of risk factors such as migraines and depressive symptoms in early adulthood may be helpful in identifying therapies for VMS.Vasomotor symptoms (VMS), consisting of hot flashes and night sweats, affect almost 80% of midlife women.1 Approximately one-half have moderate to severe symptoms,2 which are linked with decreased quality of life and work productivity.3 Risk factors for VMS are likely present years before menstruation ceases: genetic variants linked with reproductive aging are also associated with VMS,4 and studies of midlife populations have reported that VMS are often present over a decade before the cessation of menses.5 However, the timing of VMS risk factors in relation to symptoms is not well understood, because studies of VMS typically begin in midlife. Because VMS may begin earlier in reproductive life, while women are still menstruating regularly, assessment of potential VMS risk factors would ideally begin earlier in adulthood. Such an analysis could inform interventions to prevent or reduce VMS, which may be undertreated6 because of concerns regarding patient-perceived risks of existing therapies.7The Coronary Artery Risk Development in Young Adults (CARDIA) study is a population-based cohort study originally designed to identify risk factors for cardiovascular disease beginning when participants were aged 18 to 30 y until the most recent exam when women were aged approximately 60 y.8 CARDIA also has collected VMS characteristics beginning at approximately 40 y of age and every 5 y thereafter, as well as information on gynecologic surgeries, menstrual cycle length, hormone use, and reproductive histories.9 We have several a priori hypotheses based upon previous reports of risk factors for VMS collected in later life and at a single point in time. We hypothesized that risk factors associated with persistent VMS would differ from those associated with women who reported increasing VMS over time versus women who have minimal VMS in midlife. We also hypothesized that risk factors for VMS were present at baseline but that these would no longer be significant after adjustment for risk factors in later life. Finally, we also hypothesized that the strongest risk factors for persistent VMS would be adverse social determinants of health, tobacco use, and obesity. We also examined associations between persistent VMS with migrainous disorders10 as well as depressive symptoms.11Objective Previous studies have assessed potential risk factors for vasomotor symptoms (VMS) beginning in midlife. We examined whether early adulthood risk factors predict VMS trajectories over time.We performed a secondary data analysis of the Coronary Artery Risk Development in Young Adults (CARDIA) study, a population-based cohort. We included women who answered questions about VMS at three or more examinations (n = 1,966). We examined whether risk factors at baseline (when participants were aged 18-30 y; average age, 25 y) and the year 15 (Y15) exam (at ages 33-45 y; average age, 40 y) were associated with VMS trajectories from Y15 through Y35. Logistic regression models were used to evaluate the associations with VMS trajectories.We identified three trajectories of VMS presence: minimal (40%), increasing over time (27%), and persistent (33%). Baseline factors associated with persistent VMS over time included Black race, less than a high school education, depressive symptoms, migraines, cigarette use, and at Y15 hysterectomy. Baseline factors associated with increasing VMS over time included Black race and lower body mass index. Risk factors for bothersome VMS were similar and also included thyroid disease, although thyroid disease was not associated with persistence of VMS over time. Associations were similar among women who had not undergone hysterectomy and in Black and White women.Risk factors for VMS may be identified in early adulthood. Further examination of risk factors such as migraines and depressive symptoms in early adulthood may be helpful in identifying therapies for VMS.Vasomotor symptoms (VMS), consisting of hot flashes and night sweats, affect almost 80% of midlife women.1 Approximately one-half have moderate to severe symptoms,2 which are linked with decreased quality of life and work productivity.3 Risk factors for VMS are likely present years before menstruation ceases: genetic variants linked with reproductive aging are also associated with VMS,4 and studies of midlife populations have reported that VMS are often present over a decade before the cessation of menses.5 However, the timing of VMS risk factors in relation to symptoms is not well understood, because studies of VMS typically begin in midlife. Because VMS may begin earlier in reproductive life, while women are still menstruating regularly, assessment of potential VMS risk factors would ideally begin earlier in adulthood. Such an analysis could inform interventions to prevent or reduce VMS, which may be undertreated6 because of concerns regarding patient-perceived risks of existing therapies.7The Coronary Artery Risk Development in Young Adults (CARDIA) study is a population-based cohort study originally designed to identify risk factors for cardiovascular disease beginning when participants were aged 18 to 30 y until the most recent exam when women were aged approximately 60 y.8 CARDIA also has collected VMS characteristics beginning at approximately 40 y of age and every 5 y thereafter, as well as information on gynecologic surgeries, menstrual cycle length, hormone use, and reproductive histories. 9 We have several a priori hypotheses based upon previous reports of risk factors for VMS collected in later life and at a single point in time. We hypothesized that risk factors associated with persistent VMS would differ from those associated with women who reported increasing VMS over time versus women who have minimal VMS in midlife. We also hypothesized that risk factors for VMS were present at baseline but that these would no longer be significant after adjustment for risk factors in later life. Finally, we also hypothesized that the strongest risk factors for persistent VMS would be adverse social determinants of health, tobacco use, and obesity. We also examined associations between persistent VMS with migrainous disorders10 as well as depressive symptoms.11Objective Previous studies have assessed potential risk factors for vasomotor symptoms (VMS) beginning in midlife. We examined whether early adulthood risk factors predict VMS trajectories over time.We performed a secondary data analysis of the Coronary Artery Risk Development in Young Adults (CARDIA) study, a population-based cohort. We included women who answered questions about VMS at three or more examinations (n = 1,966). We examined whether risk factors at baseline (when participants were aged 18-30 y; average age, 25 y) and the year 15 (Y15) exam (at ages 33-45 y; average age, 40 y) were associated with VMS trajectories from Y15 through Y35. Logistic regression models were used to evaluate the associations with VMS trajectories.We identified three trajectories of VMS presence: minimal (40%), increasing over time (27%), and persistent (33%). Baseline factors associated with persistent VMS over time included Black race, less than a high school education, depressive symptoms, migraines, cigarette use, and at Y15 hysterectomy. Baseline factors associated with increasing VMS over time included Black race and lower body mass index. Risk factors for bothersome VMS were similar and also included thyroid disease, although thyroid disease was not associated with persistence of VMS over time. Associations were similar among women who had not undergone hysterectomy and in Black and White women.Risk factors for VMS may be identified in early adulthood. Further examination of risk factors such as migraines and depressive symptoms in early adulthood may be helpful in identifying therapies for VMS.Vasomotor symptoms (VMS), consisting of hot flashes and night sweats, affect almost 80% of midlife women.1 Approximately one-half have moderate to severe symptoms,2 which are linked with decreased quality of life and work productivity.3 Risk factors for VMS are likely present years before menstruation ceases: genetic variants linked with reproductive aging are also associated with VMS,4 and studies of midlife populations have reported that VMS are often present over a decade before the cessation of menses.5 However, the timing of VMS risk factors in relation to symptoms is not well understood, because studies of VMS typically begin in midlife. Because VMS may begin earlier in reproductive life, while women are still menstruating regularly, assessment of potential VMS risk factors would ideally begin earlier in adulthood. Such an analysis could inform interventions to prevent or reduce VMS, which may be undertreated6 because of concerns regarding patient-perceived risks of existing therapies. 7The Coronary Artery Risk Development in Young Adults (CARDIA) study is a population-based cohort study originally designed to identify risk factors for cardiovascular disease beginning when participants were aged 18 to 30 y until the most recent exam when women were aged approximately 60 y.8 CARDIA also has collected VMS characteristics beginning at approximately 40 y of age and every 5 y thereafter, as well as information on gynecologic surgeries, menstrual cycle length, hormone use, and reproductive histories.9 We have several a priori hypotheses based upon previous reports of risk factors for VMS collected in later life and at a single point in time. We hypothesized that risk factors associated with persistent VMS would differ from those associated with women who reported increasing VMS over time versus women who have minimal VMS in midlife. We also hypothesized that risk factors for VMS were present at baseline but that these would no longer be significant after adjustment for risk factors in later life. Finally, we also hypothesized that the strongest risk factors for persistent VMS would be adverse social determinants of health, tobacco use, and obesity. We also examined associations between persistent VMS with migrainous disorders10 as well as depressive symptoms.11Objective Previous studies have assessed potential risk factors for vasomotor symptoms (VMS) beginning in midlife. We examined whether early adulthood risk factors predict VMS trajectories over time.We performed a secondary data analysis of the Coronary Artery Risk Development in Young Adults (CARDIA) study, a population-based cohort. We included women who answered questions about VMS at three or more examinations (n = 1,966). We examined whether risk factors at baseline (when participants were aged 18-30 y; average age, 25 y) and the year 15 (Y15) exam (at ages 33-45 y; average age, 40 y) were associated with VMS trajectories from Y15 through Y35. Logistic regression models were used to evaluate the associations with VMS trajectories.We identified three trajectories of VMS presence: minimal (40%), increasing over time (27%), and persistent (33%). Baseline factors associated with persistent VMS over time included Black race, less than a high school education, depressive symptoms, migraines, cigarette use, and at Y15 hysterectomy. Baseline factors associated with increasing VMS over time included Black race and lower body mass index. Risk factors for bothersome VMS were similar and also included thyroid disease, although thyroid disease was not associated with persistence of VMS over time. Associations were similar among women who had not undergone hysterectomy and in Black and White women.Risk factors for VMS may be identified in early adulthood. Further examination of risk factors such as migraines and depressive symptoms in early adulthood may be helpful in identifying therapies for VMS.Vasomotor symptoms (VMS), consisting of hot flashes and night sweats, affect almost 80% of midlife women.1 Approximately one-half have moderate to severe symptoms,2 which are linked with decreased quality of life and work productivity.3 Risk factors for VMS are likely present years before menstruation ceases: genetic variants linked with reproductive aging are also associated with VMS,4 and studies of midlife populations have reported that VMS are often present over a decade before the cessation of menses.5 However, the timing of VMS risk factors in relation to symptoms is not well understood, because studies of VMS typically begin in midlife. Because VMS may begin earlier in reproductive life, while women are still menstruating regularly, assessment of potential VMS risk factors would ideally begin earlier in adulthood. Such an analysis could inform interventions to prevent or reduce VMS, which may be undertreated6 because of concerns regarding patient-perceived risks of existing therapies.7The Coronary Artery Risk Development in Young Adults (CARDIA) study is a population-based cohort study originally designed to identify risk factors for cardiovascular disease beginning when participants were aged 18 to 30 y until the most recent exam when women were aged approximately 60 y.8 CARDIA also has collected VMS characteristics beginning at approximately 40 y of age and every 5 y thereafter, as well as information on gynecologic surgeries, menstrual cycle length, hormone use, and reproductive histories.9 We have several a priori hypotheses based upon previous reports of risk factors for VMS collected in later life and at a single point in time. We hypothesized that risk factors associated with persistent VMS would differ from those associated with women who reported increasing VMS over time versus women who have minimal VMS in midlife. We also hypothesized that risk factors for VMS were present at baseline but that these would no longer be significant after adjustment for risk factors in later life. Finally, we also hypothesized that the strongest risk factors for persistent VMS would be adverse social determinants of health, tobacco use, and obesity. We also examined associations between persistent VMS with migrainous disorders10 as well as depressive symptoms.11Objective Previous studies have assessed potential risk factors for vasomotor symptoms (VMS) beginning in midlife. We examined whether early adulthood risk factors predict VMS trajectories over time.We performed a secondary data analysis of the Coronary Artery Risk Development in Young Adults (CARDIA) study, a population-based cohort. We included women who answered questions about VMS at three or more examinations (n = 1,966). We examined whether risk factors at baseline (when participants were aged 18-30 y; average age, 25 y) and the year 15 (Y15) exam (at ages 33-45 y; average age, 40 y) were associated with VMS trajectories from Y15 through Y35. Logistic regression models were used to evaluate the associations with VMS trajectories.We identified three trajectories of VMS presence: minimal (40%), increasing over time (27%), and persistent (33%). Baseline factors associated with persistent VMS over time included Black race, less than a high school education, depressive symptoms, migraines, cigarette use, and at Y15 hysterectomy. Baseline factors associated with increasing VMS over time included Black race and lower body mass index. Risk factors for bothersome VMS were similar and also included thyroid disease, although thyroid disease was not associated with persistence of VMS over time. Associations were similar among women who had not undergone hysterectomy and in Black and White women.Risk factors for VMS may be identified in early adulthood. Further examination of risk factors such as migraines and depressive symptoms in early adulthood may be helpful in identifying therapies for VMS.Vasomotor symptoms (VMS), consisting of hot flashes and night sweats, affect almost 80% of midlife women.1 Approximately one-half have moderate to severe symptoms,2 which are linked with decreased quality of life and work productivity. 3 Risk factors for VMS are likely present years before menstruation ceases: genetic variants linked with reproductive aging are also associated with VMS,4 and studies of midlife populations have reported that VMS are often present over a decade before the cessation of menses.5 However, the timing of VMS risk factors in relation to symptoms is not well understood, because studies of VMS typically begin in midlife. Because VMS may begin earlier in reproductive life, while women are still menstruating regularly, assessment of potential VMS risk factors would ideally begin earlier in adulthood. Such an analysis could inform interventions to prevent or reduce VMS, which may be undertreated6 because of concerns regarding patient-perceived risks of existing therapies.7The Coronary Artery Risk Development in Young Adults (CARDIA) study is a population-based cohort study originally designed to identify risk factors for cardiovascular disease beginning when participants were aged 18 to 30 y until the most recent exam when women were aged approximately 60 y.8 CARDIA also has collected VMS characteristics beginning at approximately 40 y of age and every 5 y thereafter, as well as information on gynecologic surgeries, menstrual cycle length, hormone use, and reproductive histories.9 We have several a priori hypotheses based upon previous reports of risk factors for VMS collected in later life and at a single point in time. We hypothesized that risk factors associated with persistent VMS would differ from those associated with women who reported increasing VMS over time versus women who have minimal VMS in midlife. We also hypothesized that risk factors for VMS were present at baseline but that these would no longer be significant after adjustment for risk factors in later life. Finally, we also hypothesized that the strongest risk factors for persistent VMS would be adverse social determinants of health, tobacco use, and obesity. We also examined associations between persistent VMS with migrainous disorders10 as well as depressive symptoms.11Objective Previous studies have assessed potential risk factors for vasomotor symptoms (VMS) beginning in midlife. We examined whether early adulthood risk factors predict VMS trajectories over time.We performed a secondary data analysis of the Coronary Artery Risk Development in Young Adults (CARDIA) study, a population-based cohort. We included women who answered questions about VMS at three or more examinations (n = 1,966). We examined whether risk factors at baseline (when participants were aged 18-30 y; average age, 25 y) and the year 15 (Y15) exam (at ages 33-45 y; average age, 40 y) were associated with VMS trajectories from Y15 through Y35. Logistic regression models were used to evaluate the associations with VMS trajectories.We identified three trajectories of VMS presence: minimal (40%), increasing over time (27%), and persistent (33%). Baseline factors associated with persistent VMS over time included Black race, less than a high school education, depressive symptoms, migraines, cigarette use, and at Y15 hysterectomy. Baseline factors associated with increasing VMS over time included Black race and lower body mass index. Risk factors for bothersome VMS were similar and also included thyroid disease, although thyroid disease was not associated with persistence of VMS over time. Associations were similar among women who had not undergone hysterectomy and in Black and White women.Risk factors for VMS may be identified in early adulthood. Further examination of risk factors such as migraines and depressive symptoms in early adulthood may be helpful in identifying therapies for VMS.Vasomotor symptoms (VMS), consisting of hot flashes and night sweats, affect almost 80% of midlife women.1 Approximately one-half have moderate to severe symptoms,2 which are linked with decreased quality of life and work productivity.3 Risk factors for VMS are likely present years before menstruation ceases: genetic variants linked with reproductive aging are also associated with VMS,4 and studies of midlife populations have reported that VMS are often present over a decade before the cessation of menses.5 However, the timing of VMS risk factors in relation to symptoms is not well understood, because studies of VMS typically begin in midlife. Because VMS may begin earlier in reproductive life, while women are still menstruating regularly, assessment of potential VMS risk factors would ideally begin earlier in adulthood. Such an analysis could inform interventions to prevent or reduce VMS, which may be undertreated6 because of concerns regarding patient-perceived risks of existing therapies.7The Coronary Artery Risk Development in Young Adults (CARDIA) study is a population-based cohort study originally designed to identify risk factors for cardiovascular disease beginning when participants were aged 18 to 30 y until the most recent exam when women were aged approximately 60 y.8 CARDIA also has collected VMS characteristics beginning at approximately 40 y of age and every 5 y thereafter, as well as information on gynecologic surgeries, menstrual cycle length, hormone use, and reproductive histories.9 We have several a priori hypotheses based upon previous reports of risk factors for VMS collected in later life and at a single point in time. We hypothesized that risk factors associated with persistent VMS would differ from those associated with women who reported increasing VMS over time versus women who have minimal VMS in midlife. We also hypothesized that risk factors for VMS were present at baseline but that these would no longer be significant after adjustment for risk factors in later life. Finally, we also hypothesized that the strongest risk factors for persistent VMS would be adverse social determinants of health, tobacco use, and obesity. We also examined associations between persistent VMS with migrainous disorders10 as well as depressive symptoms.11