New research presented at the 2021 North American Menopause Society (NAMS) Annual Meeting in Washington, DC, held September 2225, 2021, highlighted how many of the conditions and symptoms experienced in menopause are linked, and how they may impact our health as we age.

New data identified a link between the density of the fat around the heart and cognitive function in midlife women, and how it might affect Black women differently.

The findings provide further clues on how the declining cardiovascular health that happens after menopause may contribute to the increased prevalence of dementia in women. Nearly two-thirds of Americans with Alzheimer's are women, according to the Alzheimers Association.

What's new We know that fat around the midsection, including the heart, isnt good, says Stephanie S. Faubion, MD, the director of the Center for Womens Health at the Mayo Clinic in Rochester, Minnesota. Waist circumference alone is an important marker for cardiovascular disease; even normal-weight women who have a thicker waistline are at higher risk, she says.

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Research details In this new study, investigators used data fromSWAN (Study of Women's Health Across the Nation) to assess the associations of heart fat volume and radiodensity (the density of fat measured with a special machine) with future cognitive performance among midlife women.

Of the nearly 500 participants, 30.6 percent were post-menopausal and 35.9 percent were Black. Racial differences in the associations were specifically analyzed to further investigate a seeming contradiction; on average, Black Americans have lower cardiovascular fat volume but have a higher risk of heart disease and a higher prevalence of Alzheimer's disease compared with white Americans, according to the researchers.

Study results showed that a higher perivascular adipose tissue (PVAT) radiodensity (higher density) was significantly associated with a worse performance in working memory. Researchers also found a significant interaction between fat around the heart and race. A higher baseline PVAT radiodensity at midlife was associated with lower future performance in verbal episodic memory among Black women, but not white women. Those associations remained even after researchers controlled for the volume of heart fat, as well as waist circumference and other known confounders.

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Why it matters This study is furthering our understanding about fat around the heart, says Dr. Faubion, who is also the medical director of theNorth American Menopause Society (NAMS). Its not just how much fat, but also the quality of fat around the heart that could determine health risk, and not just for heart disease; now were seeing it connected to dementia risk, too. Its all tied together, she says.

A higher vascular risk is bad for the brain because a lot of dementia risk really has to do with blood vessel health, adds Faubion.

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The results suggest that the density of fat around the heart could serve as a novel biomarker of cognitive function status in women later in life, says Samar El Khoudary, PhD, MPH, a researcher at the University of Pittsburgh School of Public Health and a lead author of the study. Dr. El Khoudary has published other studies that look at heart fat accumulation in women and how it impacts the arteries.

We still need more research to better understand what we have reported. At this stage, we can only stress the importance of thinking about risk factors of heart diseases, including visceral fat around vasculature, as shared risk factors that could also be related to brain health, she says. Interventions that address these shared risk factors may benefit both the heart and the brain, adds El Khoudary.

Right now, we dont know why higher density fat is worse, says Faubion. It may be because its more active, she says.

Is fat density modifiable or is it more like breast tissue density and cant be changed? Thats a good question. I dont know if you can change the density of the fat, says Faubion. Given what we currently know, the goal should be to have a healthy amount of fat, she says.

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Even if you spend eight or nine hours in bed, you may still accrue poor-sleep-related outcomes unless you fix your WASO, saidHadine Joffe, MD, the executive director of the Connors Center for Womens Health and Gender Biology, who presented on the topic during a symposium at NAMS.

What's new WASO, short for "wake time after sleep onset," is associated with adverse consequences for mental health, daytime well-being, and metabolic health for women during midlife, said Dr. Joffe, who is also the director of the Womens Hormone and Aging Research Program at Brigham and Womens Hospital and Harvard Medical School, during her presentation.

Research details Data suggests that menopause-pattern sleep fragmentation may impact metabolism and contribute to an increase in body fat, which happens in about half of all women during and after menopause, she said.

The focus has always been on getting enough sleep; we always ask, Have you been getting at least seven hours of sleep? says Kristi Tough DeSapri, MD, an assistant professor of medicine at Northwestern University and a physician at the Northwestern Medicine Center for Sexual Medicine and Menopause in Chicago.

Thats often the public service message that is out there get enough sleep but during the menopause transition it may be more beneficial to focus on sleep quality, she says. Finding ways to improve sleep efficiency, less waking during the night, whether thats from menopause symptoms or other reasons, are important to consider, rather than simply the number of hours we sleep, says Dr. DeSapri.

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Why it matters There is a connection between menopausal symptoms, such as hot flashes and night sweats, and WASO, and it might be appropriate to try hormone therapy or management of hot flashes to address those, says Faubion. There are also a number of reasons that have nothing to do with your health that could interrupt your sleep as well, everything from your partner snoring to your old dog getting up to pee every hour, she says. Alcohol, bladder issues, and mood may also be behind interrupted sleep, says Faubion.

WASO is absolutely worth working on either on your own or with the help of your provider, she adds.

A new study from Mayo Clinic confirms a link between a history of migraine and hot flashes and highlights the association of both phenomena with an increased risk of heart disease.

A prior study from SWAN showed a connection, and we wanted to see if our data would corroborate that finding, says Faubion, the lead author of the study.

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What's new We found that the correlation between hot flashes and migraine was significant, and the correlation with the severity of hot flashes was significant: The more severe your hot flashes were, the more likely you were going to report severe migraines, says Faubion.

Research details The cross-sectional analysis used theData Registry on the Experiences of Aging, Menopause, and Sexuality (DREAMS), which was completed by women ages 45 to 60 who visited one of the Mayo Clinic locations in Minnesota, Arizona, and Florida. A total of 3,308 women were included; the population was 94.5 percent white, 93 percent had at least some college, and 27 percent reported a history of migraine.

The nature of the relationship is still unknown, Faubion says. Its also unclear [whether] migraine and hot flashes are separate things that are both tied to heart disease risk or if they share a common pathophysiology, says Faubion.

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Why it matters These findings could help us be more proactive in offering treatment and lifestyle interventions for menopause symptoms in women with a history of migraine, she says.

More research is needed to determine whether having both a history of migraine and hot flashes in midlife predict greater heart disease risk than either factor on its own, and whether these female-specific factors could be used to enhance the accuracy of CVD risk calculations for women, says Faubion.

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Menopause Symptoms Predict Risk of Heart, Memory Trouble - Everyday Health

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