Vasomotor symptoms and heart failure in midlife women of the CARDIA study

Objective: Current evidence has demonstrated associations of vasomotor symptoms (VMS) with cardiovascular disease risk factors and subclinical atherosclerosis. However, the relationship between VMS and incident heart failure (HF) is unknown. We evaluated the associations of VMS occurrence over the study duration and VMS intensity at baseline with incident HF in a large cohort of middle-aged Black and White women. Methods: We included 2,026 middle-aged Black and White women from the Coronary Artery Risk Development in Young Adults study who participated in the 2000-2001 study exam (baseline). VMS intensity was categorized as moderate-to-severe for participants who reported VMS that bothered or limited their activities a lot, and mild for those who reported VMS that bothered or limited their activities a little or not at all. HF events were recorded till the end of follow-up in 2022. Cox proportional hazards models were used for analysis. Results: The mean (SD) age of participants was 40.2 (3.7) years. Out of 518 women who experienced VMS at baseline, 107 reported moderate-to-severe VMS. Thirty-two women developed fatal or nonfatal HF over a median (IQR) follow-up of 22.8 (22.5-23.0) years. Neither VMS occurrence during follow-up, moderate-to-severe or mild VMS intensity at baseline were significantly associated with HF incidence, hazard ratios (95% CI): 0.58 (0.23-1.42), 0.62 (0.17-2.25) and 0.45 (0.12-1.69), respectively. However, our analysis was limited by a few HF events, which restricted our ability to make definite conclusions. Conclusion: VMS occurrence and VMS intensity were not significantly associated with HF incidence among middle-aged women, possibly due to limited statistical power.