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For middle-aged women suffering from migraines, or hot flashes and night sweats, another worry may be lingering on their minds: Did those experiences set them up for a heart attack, stroke or other cardiovascular crisis? Is.

However, past research has received much attention during and after menopause.

But a pair of new studies in the journal Menopause suggest that most of them don’t need to worry too much, especially if they don’t have both migraines and long-term hot flashes and night sweats.

Instead, they should focus on addressing other factors that can reduce their cardiovascular risk by getting more sleep, exercising and eating healthy foods, quitting tobacco, and watching their blood pressure, blood sugar, cholesterol, and weight. can increase

For women who have experienced migraines and hot flashes or night sweats for several years, a new study suggests an additional level of cardiovascular risk. That makes preventing heart disease and stroke even more important in this group, says study leader Kathryn Kim, MD, MPH, of the University of Michigan.

And for women who currently experience migraines in their 20s and 30s, new research suggests they may be at greater risk of long-term menopausal symptoms as they get older.

Long-term studies yield important insights.

Kim and colleagues at the Academic Medical Center of Michigan Medicine, UM, have published a new pair of studies based on an in-depth analysis of data from a long-term study of more than 1,900 women who had regular physicals. Volunteered to get checkups and blood tests, and to take annual health surveys, when they were in their late teens to early 30s.

The women, now in their 50s and 60s, have provided researchers with an invaluable view of what factors shape health during menopause and beyond through their continued participation in the CARDIA study.

“The anxiety and fear that women with migraines and menopausal symptoms feel about cardiovascular risk is real — but these findings suggest that focusing on prevention, and addressing unhealthy habits and risk factors Fixing can help most women,” said Kim, a colleague. Professor of internal medicine and primary care physician at UM.

She adds, “For the subgroup with both migraine and early persistent hot flashes and night sweats, and for those currently experiencing migraines in their youth, these findings suggest that the risks may be manageable.” and point to an additional need to address symptoms early.”

Just over 30 percent of middle-aged women in the study reported experiencing persistent hot flashes and night sweats, collectively known as vasomotor symptoms or VMS because they are related to changes in blood vessel diameter. .

23 percent of them also reported having migraines. This was the only group for which Kim and colleagues found an excess risk of stroke, heart attack or other cardiovascular events that could not be explained by other risk factors that have long been linked to cardiovascular problems.

In addition to those with persistent vasomotor symptoms starting at 40 or earlier, 43% of women in the study had their lowest level of such symptoms in their 50s, and 27% in their 50s and 60s. experienced an increase in VMS over time in the early 1990s.

The latter two groups had no additional cardiovascular risk when their other risk factors were taken into account, whether or not they had migraine. The use of hormone-based birth control and estrogen to address medical problems did not affect this risk.

Controlling destiny

In a study of data from the same women earlier in life, researchers found that the biggest predictors of persistent hot flashes and night sweats were migraines, depression, and depression. , and smoking included. Being black or having less than a high school education.

“These two studies, taken together, indicate that not all women have the same experiences with aging, and that many can control these risk factors,” Kim said. which can increase their chances of heart disease and stroke later in life.” “In other words, women can do a lot to control their fate when it comes to both menopausal symptoms and cardiovascular disease.”

She notes that the American Heart Association calls these risk factors the “Essential 8” and offers guidance on what women, men, and even children and teens can do to combat them.

Developing knowledge and treatment

The long-term study that led to the two new findings was designed specifically to look at cardiovascular risk when it began in the mid-1980s. Cardia Means Coronary Artery Risk Development in Young Adults.

In the 80s, knowledge of the biology of blood vessels, down to the cellular and molecular level, was nowhere near where it is today. Both vasomotor symptoms in menopause and migraine are related to vasoconstriction and dilation.

But decades of research have shown the microscopic effects on blood vessels of smoking, poor sleep, poor eating habits and lack of activity, as well as a person’s genetic inheritance, life experiences and hormonal history.

In recent years, new injectable migraine medications called calcitonin gene-related peptide (CGRP) antagonists have hit the market.

Using monoclonal antibodies, they target a key receptor on the surface of blood vessel cells to prevent migraines and cluster headaches. But they are expensive and not covered by insurance for all people who suffer from migraines.

While the new research is based on data from years before these drugs became available, Kim said she recommends them to her patients with persistent migraines, as well as understanding them. Also works for what triggers their migraines and how to use other medications, including pain relievers. Antiseizure medications to prevent them.

She also notes that the paper on the future risk of persistent hot flashes and night sweats echoes the recent trend of using antidepressant medications to try to reduce these menopausal effects.

Kim also says there is growing evidence for the importance of healthy sleep habits in reducing hot flashes, as well as the short-term use of estradiol-based hormone therapy patches, which are not associated with cardiovascular risk. is shown. And, she notes that research has not shown any over-the-counter supplement or herbal treatment to be effective, and that these are far less well-regulated than drugs.

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