Vasomotor menopausal symptoms and cardiovascular disease risk in midlife: A longitudinal study

•Previous studies found contradictory results of the association between vasomotor menopausal symptoms and cardiovascular outcomes.•We found no convincing association between vasomotor menopausal symptoms or the duration of symptoms and cardiovascular outcomes.•This is de largest study to date of the association of vasomotor menopausal symptoms and cardiovascular outcomes.•This is the only study to have investigated the duration of menopausal symptoms in relation to cardiovascular outcomes. To ascertain the association between vasomotor menopausal symptoms (VSM), hot flushes and night sweats, and cardiovascular disease, coronary heart disease and cerebrovascular disease. The study sample comprised 8881 women (aged 45–50 years) with available hospital separation data from the 1946-51 cohort (1996–2016) of the ongoing Australian Longitudinal Study on Women’s Health, a national prospective cohort study. First fatal or non-fatal cardiovascular disease, coronary heart disease, and cerebrovascular disease events were obtained through linkage with hospital admission data, the National Death Index, and Medicare Benefits Schedule. Hot flushes and night sweats were assessed via questionnaires at each main survey. Additionally, we calculated the duration of symptoms based on whether or not women reported vasomotor menopausal symptoms in each survey. There were 925 cardiovascular disease, 484 coronary heart disease and 154 cerebrovascular disease events. There was no consistent evidence of any association with vasomotor menopausal symptoms, hot flushes and night sweats. We did find marginally statistically significant associations between presence of night sweats and cardiovascular disease (Hazard Ratio = 1.18, 95 % Confidence Interval: 1.01–1.38), and between the duration of vasomotor menopausal symptoms [years] and coronary heart disease (Hazard Ratioper year = 1.03, 95 % Confidence Interval: 1.00–1.05). However, given the number of associations tested, these findings could very well have arisen by chance. In this large longitudinal study with 20 years of follow-up and clinical outcomes we did not find a convincing association between vasomotor menopausal symptoms, hot flushes, night sweats and cardiovascular disease, coronary heart disease and cerebrovascular disease.