VMS and Cardiovascular Risk: Mechanisms, Risk Factors, and Prevention

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.

Dr. Kristi DeSapri broadens the discussion to note that even without VMS, the estrogen decline of menopause drives meaningful changes in lipid profiles and vascular resistance, reinforcing the view that menopause represents a whole-body transition requiring a multidisciplinary approach rather than a purely gynecologic one.

Both experts agree that the perimenopause and menopause transition represents a valuable opportunity for cardiovascular risk screening, particularly for women with relevant family histories, adverse pregnancy outcomes such as preeclampsia, or pre-existing cardiometabolic risk factors. With up to 90% of cardiovascular disease considered preventable, the panelists stress the importance of consistent, cross-specialty messaging to close the gap in women's cardiovascular care.

The next episode in this series, "Cardiovascular Risk Assessment and VMS Management in Menopausal Care," features the panelists examining current gaps in cardiovascular risk assessment for menopausal women, walking through updated guideline-based tools and risk enhancers, and emphasizing the importance of individualized, ongoing risk evaluation when considering treatment options for VMS.