Beyond Hot Flashes: Navigating Vasomotor Symptoms and Cardiovascular Health in Primary Care Settings
Welcome back to another Patient Care Online Peers & Perspectives series. The segment opens with introductions from moderator, Dr. Kristi DeSapri, a board-certified internist with fellowship training in midlife and menopause care, and panelist, Dr. Erin Michos, a cardiologist who directs a women's cardiovascular health and multidisciplinary menopause program. The discussion centers on vasomotor symptoms (VMS) — clinically defined as hot flashes and night sweats — and their broad effects on women's health during the menopausal transition.
In this episode, "VMS and Cardiovascular Risk: Mechanisms, Risk Factors, and Prevention," the experts explore the underlying mechanisms that connect vasomotor symptoms to increased cardiovascular risk and discuss how clinicians across specialties can better identify and address that risk.
Dr. Erin Michos outlines several proposed pathophysiological pathways linking VMS to cardiovascular disease. Women with more severe VMS tend to present with worse cardiometabolic profiles, including elevated blood pressure, insulin resistance, adverse lipid levels, and metabolic syndrome. VMS are also discussed as potential markers of endothelial dysfunction, evidenced by reduced flow-mediated dilation, as well as autonomic nervous system dysregulation — characterized by increased sympathetic and decreased parasympathetic tone. Additionally, HPA axis dysregulation, reflected in blunted morning cortisol and elevated urinary cortisol, may further explain the cardiovascular association.
In "Cardiovascular Risk Assessment and VMS Management in Menopausal Care," our panel explores the inadequacies in current cardiovascular risk assessment practices for menopausal women and presents a comprehensive, guideline-informed framework for improving that care.
This episode, titled "Hormonal and Non-Hormonal Treatment Options in VMS," features panelists walking through the full spectrum of evidence-based treatment options for vasomotor symptoms, grounded in The Menopause Society position statement and decades of clinical and research experience.
In this episode, "Navigating Menopausal Hormone Therapy Safety in VMS," the experts explore the nuances of menopausal hormone therapy (MHT) safety, addressing persistent misconceptions that have affected both clinical practice and patient decision-making since the FDA's black box warning.
In "Novel Non-Hormonal Therapies for VMS: Mechanisms and Clinical Evidence," our panel explores the neurophysiology underlying vasomotor symptoms and the clinical significance of two FDA-approved neurokinin receptor antagonists that represent a meaningful advance in non-hormonal VMS treatment.
This episode, titled "Safety and Cardiovascular Considerations of Novel Non-Hormonal VMS Therapies," features panelists conducting a detailed review of the safety data for the two newest FDA-approved non-hormonal treatments for VMS — fezolinetant and elinzanetant — with a particular focus on hepatic monitoring, cardiovascular safety, and practical clinical application.
This episode, titled "Elinzanetant for VMS in Breast Cancer Patients: Insights from the OASIS-4 Trial," features panelists discussing the OASIS-4 trial — a study specifically designed to evaluate elinzanetant in women with a history of breast cancer — and its implications for a patient population that has historically had very limited options for VMS management.
In this episode, "Practical Strategies for Managing VMS and Cardiovascular Risk in Primary Care," the panelists explore practical approaches to help busy primary care providers incorporate both cardiovascular risk assessment and vasomotor symptom screening into their everyday clinical workflow without sacrificing efficiency or quality of care.
In the final episode, "A Multidisciplinary Approach to VMS and Cardiovascular Health," the panelists explore how effective, team-based care across specialties can optimize health outcomes for women navigating the menopausal transition, and offer closing reflections on the evolving landscape of VMS and cardiovascular risk management.
