Does everyday discrimination account for the increased risk of vasomotor symptoms in Black women?: the Study of Women's Health Across the Nation (SWAN)

OBJECTIVES

Vasomotor symptoms (VMS), including hot flashes and night sweats, are hallmark symptoms of the menopause transition. Previous research has documented greater frequency, duration, and severity of VMS in Black women compared with women from other racial/ethnic groups, even after accounting for other factors. This analysis examined the association between discrimination and VMS and the extent to which discrimination accounts for the disproportionate burden of VMS in Black women.

METHODS

Using available discrimination and VMS data from the SWAN cohort study (n = 2,377, 48% White, 32% Black, 6% Japanese, 4% Chinese, and 9% Hispanic women) followed approximately yearly in midlife from premenopause (42-52 y) through postmenopause (~20 y), we assessed concurrent associations between discrimination and VMS frequency in the past 2 weeks using weighted generalized mixed models. We also assessed associations between chronic discrimination across first four visits and VMS trajectories from premenopause to postmenopause using weighted multinomial logistic regression. Models were adjusted for known risk factors for VMS.

RESULTS

Higher levels of discrimination were associated with concurrent reporting of any (odds ratio [OR], 1.57 [1.31-1.89]) and frequent (≥6 d) VMS (OR, 1.55 [1.21-1.99]). After adjustment, associations remained significant for any (OR, 1.30 [1.09-1.54]) but not frequent VMS. For any VMS trajectories, chronic discrimination was associated with "continuously high" (OR, 1.69 [1.03-2.77]) and "high pre-FMP-decline post-FMP" (OR, 1.70 [1.01-2.88]) versus "FMP-onset low" trajectories. After adjusting for discrimination, odds of reporting any, frequent, and of being in the "continuously high" any VMS trajectory remained elevated for Black versus White women.

CONCLUSIONS

Discrimination is associated with greater concurrent risk of any (but not frequent) VMS, and chronic discrimination is associated with a continuously high reporting of any VMS over time, independent of known risk factors. Adjusting for discrimination attenuates but does not eliminate the increased risk of VMS for Black women.

Daily spiritual experiences and allostatic load trajectories: a longitudinal study of midlife African American women

OBJECTIVE

This study aimed to evaluate the association between daily spiritual experiences and allostatic load (AL) trajectories in midlife African American women.

METHODS

A longitudinal analysis of public-use data from 727 African American women in the Study of Women's Health Across the Nation (SWAN) was performed. We included African American women who completed the Daily Spiritual Experiences Scale at SWAN visit 4 (2000-2001) and had AL data at three or more study visits over 7 years. AL was calculated at each visit using 10 biomarkers: systolic and diastolic blood pressure, body mass index, C-reactive protein, high-density lipoprotein cholesterol, total cholesterol, waist-to-hip ratio, fasting serum glucose, triglycerides, and dehydroepiandrosterone. Group-based trajectory modeling identified women with similar patterns of AL. We used multinomial logistic regression to estimate associations between daily spiritual experiences (some days or less, most days, daily, many times a day) and AL trajectories.

FINDINGS

Our sample had a mean ± SD age of 49.9 ± 2.66 years, 47% were early perimenopausal, and 17% earned <$19,999 annually. The mean ± SD AL score was 2.52 ± 1.68. Three AL trajectories were identified: low (35.1%), moderate (44.7%), and high (20.2%). In age-adjusted models, women who reported daily comfort in religion and spirituality were less likely to follow a high AL trajectory (odds ratio, 0.41; 95% CI, 0.18-0.93); the association was attenuated when controlling for depressive symptoms (odds ratio, 0.48; 95% CI, 0.19-1.21).

CONCLUSIONS

Findings from this study do not support an independent association between spirituality in African American women and AL trajectories in midlife. Studies with a larger sample and additional measures of spirituality are warranted in this population.

Caregivers' Contributions to Heart Failure Self-care: An Updated Systematic Review

BACKGROUND

A previous systematic review reporting the contributions of informal, unpaid caregivers to patient heart failure (HF) self-care requires updating to better inform research, practice, and policy.

OBJECTIVE

The aim of this study was to provide an updated review answering the questions: (1) What specific activities do informal caregivers of adults with HF take part in related to HF self-care? (2) Have the activities that informal caregivers of adults with HF take part in related to HF self-care changed over time? (3) What are the gaps in the science?

METHODS

This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, CINAHL, EMBASE, and Cochrane CENTRAL databases were searched. Eligible studies involved an informal, unpaid caregiver of an adult with HF as a study variable or participant. Caregiving activities were benchmarked using the theory of self-care in chronic illness.

RESULTS

Two thousand one hundred fifty-four research reports were identified, of which 64 met criteria. Caregivers' contributions occurred in self-care maintenance (91%), monitoring (54%), and management (46%). Activities performed directly on or to the patient were reported more frequently than activities performed for the patient. Change over time involved the 3 domains differentially. Gaps include ambiguous self-care activity descriptions, inadequate caregiving time quantification, and underrepresented self-care monitoring, supportive, and communication activities.

CONCLUSIONS

Newly identified caregiver-reported activities support updating the theory of self-care in chronic illness to include activities currently considered ancillary to HF self-care. Identified gaps highlight the need to define specific caregiving activities, determine task difficulty and burden, and identify caregiver self-care strategy and education needs. Exposing the hidden work of caregiving is essential to inform policy and practice.

Reproductive period duration and cognitive function in postmenopausal Latina women in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

OBJECTIVES

A shorter reproductive period, a marker of estrogen exposure, has been related to cognitive impairment among older (>65 years) non-Hispanic White women. We explored whether reproductive period duration, age at menarche, and age at menopause are related to cognitive function among postmenopausal Hispanic/Latina women.

METHODS

This cross-sectional analysis used baseline (Visit 1: 2008-2011) data from 3630 postmenopausal women in the Hispanic Community Health Study/Study of Latinos. Reproductive period duration, age at menarche, and age at menopause were assessed by self-report. Cognitive function variables included global cognition, verbal learning, memory, verbal fluency, and processing speed. Associations between each reproductive event and cognitive function were examined using multivariable linear and logistic regression analyses accounting for the complex survey design of the study and adjusting for socio-demographics, parity, and cardiovascular risk factors. We assessed whether associations differed by type of menopause (natural versus surgical) and hormone therapy use.

RESULTS

The study population was on average aged 59 years, with a mean reproductive period duration of 35 years. Older age at menopause and a longer reproductive period were related to higher verbal learning (β = 0.04, SE = 0.02; p < 0.05) and processing speed (ß = 0.16, SE = 0.04; p < 0.001); associations were more pronounced for women with natural menopause. Older age at menarche was associated with lower scores on the digit symbol substitution test (ß = -0.62, SE = 0.15; p < 0.0001). There were no associations with global cognition.

CONCLUSION

Among postmenopausal Hispanic/Latinas, a longer reproductive period was related to more favorable cognitive measures of verbal learning and processing speed. Our findings support the hypothesis that greater lifetime exposure to estrogens may be associated with higher cognitive performance.

Number of prior live births is associated with higher arterial stiffness but not its change in older women: the atherosclerosis risk in communities study

Introduction

Although studies have demonstrated a J-shaped association between parity and cardiovascular disease (CVD), the association with arterial stiffness is not fully understood.

Methods

We examined the association between parity and carotid-femoral pulse wave velocity (cfPWV), a measure of central arterial stiffness. We conducted a longitudinal analysis of 1220 women (mean age 73.7 years) who attended the Atherosclerosis Risk in Communities Study visit 5 (2011-2013). At visit 2 (1990-1992), women self-reported parity (number of prior live births), which we categorized as: 0 (never pregnant or pregnant with no live births); 1-2 (referent); 3-4; and 5+ live births. Technicians measured cfPWV at visit 5 (2011-2013) and visit 6 or 7 (2016-2019). Multivariable linear regression modeled the associations of parity with visit 5 cfPWV and cfPWV change between visit 5 and 6/7 adjusted for demographics and potential confounding factors.

Results

Participants reported 0 (7.7%), 1-2 (38.7%), 3-4 (40.0%), or 5+ (13.6%) prior live births. In adjusted analyses, women with 5+ live births had a higher visit 5 cfPWV (β=50.6 cm/s, 95% confidence interval: 3.6, 97.7 cm/s) than those with 1-2 live births. No statistically significant associations were observed for other parity groups with visit 5 cfPWV or with cfPWV change.

Discussion

In later life, women with 5+ live births had higher arterial stiffness than those with 1-2 live births, but cfPWV change did not differ by parity, suggesting women with 5+ live births should be targeted for early primary prevention of CVD given their higher arterial stiffness at later-life.

Health Care Access and Health Indicators in Puerto Rico Pre- and Post- Hurricane Maria: Behavioral Risk Factor Surveillance System (2015-2019)

Hurricane Maria is regarded as one of the worst natural disasters in United States history as it devasted Puerto Rico (PR) in September 2017. This study compared population-based key health indicators among PR residents pre-and post-Hurricane Maria. We examined Behavioral Risk Factor Surveillance System (BRFSS) PR data from five survey years, including pre-and post-Hurricane Maria: 2015 (N = 4556), 2016 (N = 5765), 2017 (N = 4462), 2018 (N = 4814), and 2019 (N = 4958). The sample consisted of non-institutionalized adults aged ≥ 18 years with access to a landline or a cellular telephone. Using logistic regression we compared health care utilization, health behaviors, and outcomes pre-and post-Hurricane Maria. Models adjusted for age, sex, race, education, employment, income, and marital status (2017 = referent). Compared to 2017, post-hurricane participants were more likely to have a college degree or higher, be currently employed, and not married/partnered. Post-hurricane, participants were less likely to have health insurance coverage (2018 AOR, 95% CI: 0.75, 0.58-0.97) and had lower rates of diabetes (2018 AOR: 0.82, 0.70-0.96). The odds of being overweight/obese were lower pre-hurricane compared to 2017 (2015 AOR, 95% CI: 0.88, 0.79-0.97). There was no statistically significant difference in health behaviors across survey years. Results may suggest that PR residents with lower socioeconomic status and/or chronic illness were more likely to emigrate, resulting in a compositional change in the population post-hurricane. This analysis highlights the need for long-term follow-up of PR residents to better determine the impact of Hurricane Maria, and adequately design public health programs to address healthcare needs, access, and outcomes.

Mapping definitions, measures and methodologies of assessing police violence in the health literature: a scoping review protocol

INTRODUCTION

Police violence is a growing public health issue in the USA. Emerging evidence suggests that negative police encounters are associated with adverse physical and mental health outcomes. There is a critical need to examine the relationship between police violence and health disparities. However, the lack of consensus on a conceptual and operational definition of police violence is a limitation in scientific investigations on police violence and its health impacts. Here, we present the protocol for a scoping review that maps definitions, measures and methodologies of assessing police violence in the health literature.

METHODS AND ANALYSIS

We will comprehensively search PubMed, Cumulative Index to Nursing and Allied Health Literature and APA PsycInfo databases. We will use the following string of key terms separated with the Boolean operator 'or': 'police violence', 'police brutality', 'police use of force', 'law enforcement violence', 'law enforcement brutality', 'law enforcement use of force' and 'legal intervention'. An English language limit will be applied. We will include studies published in English or that have an English language abstract available. Eligible studies will include: (1) a definition of police violence and/or (2) a measurement of police violence.

ETHICS AND DISSEMINATION

This scoping review does not require ethical approval. The findings of this review will be disseminated through publication in a peer-reviewed journal and at conferences.

Symptom experience during the late reproductive stage versus the menopausal transition in the Spanish-language Women Living Better survey

OBJECTIVES

The aim of this study was to characterize and compare the symptoms women self-report during the late reproductive stage and the menopausal transition.

METHODS

This cross-sectional analysis used data from the Spanish-language Women Living Better survey. Women aged 35 to 55 years completed an 82-item online survey to assess menstrual cycle patterns, changes, and 61 symptoms sometimes associated with menopause. Women's menstrual patterns were classified as late reproductive stage or menopausal transition using the Stages of Reproductive Aging Workshop. Demographic and health-related data were collected, including age, country of residence, race/ethnicity, education, parity, smoking, and alcohol use. Descriptive statistics characterized reported symptoms, and logistic regression models examined associations between reproductive stage and symptoms.

RESULTS

Of 853 respondents, 358 women were included in the sample analyzed. Participants were on average 40 ± 4.1 years old, 46% reported difficulty paying for basics, 34% lived in Spain, and 20% lived in Mexico. A similar proportion of women in the late reproductive stage and menopausal transition reported 8 of 18 symptom groups. Women in the late reproductive stage had a lower age-adjusted odds of musculoskeletal pain (odds ratio, 0.35; 95% CI, 0.19-0.66) and lower odds of decreased interest in sex (odds ratio, 0.49; 95% CI, 0.25-0.92). Both groups of women reported a similar interference with personal relationships.

CONCLUSIONS

Late-reproductive-stage women experience multiple symptoms often associated with menopause. A better understanding of symptoms experienced among Spanish-speaking women may lead to more personalized health care and facilitate anticipatory guidance about menopause. Future cross-cultural studies focusing on symptoms during the late reproductive stage are necessary.

Cardiovascular Disease-Related Emergency Department Visits and Hospitalization among Women with Hypertensive Disorders of Pregnancy

INTRODUCTION

The risk of developing cardiovascular disease is higher for women who had hypertensive disorders of pregnancy than for women without a history of hypertensive disorders of pregnancy. However, it is unknown whether the emergency department visits and hospitalization differ between women with a history of hypertensive disorders of pregnancy and women without hypertensive disorders of pregnancy. The objective of this study was to characterize and compare cardiovascular disease-related emergency department visits, hospitalization rates, and diagnoses in women with a history of hypertensive disorders of pregnancy with those in women without.

METHOD

This study included participants from the California Teachers Study (N=58,718) with a history of pregnancy and data from 1995 through 2020. Incidence of cardiovascular disease-related emergency department visits and hospitalizations based on linkages with hospital records were modeled using multivariable negative binomial regression. Data were analyzed in 2022.

RESULTS

A total of 5% of the women had a history of hypertensive disorders of pregnancy (5.4%, 95% CI=5.2%, 5.6). A total of 31% of women had 1 or more cardiovascular disease-related emergency department visits (30.9%), and 30.1% had 1 or more hospitalizations. The incidence of cardiovascular disease-related emergency department visits (adjusted incident rate ratio=8.96, p<0.001) and hospitalizations (adjusted incident rate ratio=8.88, p<0.001) were significantly higher for women with hypertensive disorders of pregnancy than for those without, adjusting for other related characteristics of the women.

CONCLUSIONS

History of hypertensive disorders of pregnancy is associated with higher cardiovascular disease-related emergency department visits and hospitalizations. These findings underscore the potential burden on women and the healthcare system of managing complications associated with hypertensive disorders of pregnancy. Evaluating and managing cardiovascular disease risk factors in women with a history of hypertensive disorders of pregnancy is necessary to avoid cardiovascular disease-related emergency department visits and hospitalizations in this group.

Palpitations across the menopause transition in SWAN: trajectories, characteristics, and associations with subclinical cardiovascular disease

OBJECTIVE

Our objectives were to identify trajectories of palpitations over the menopause transition, characterize them, and examine associations with subclinical cardiovascular disease (CVD).

METHODS

We analyzed the following data from the multisite, multiethnic SWAN (Study of Women Across the Nation): reported palpitations occurrence over time; baseline sociodemographic, reproductive, medication, and health-related factors; and follow-up visit subclinical CVD (carotid atherosclerosis, vascular stiffness). Trajectories of palpitations (n = 3,276), their characteristics, and their associations with subclinical CVD (n = 1,559) were identified using group-based trajectory modeling and linear and logistic regression models.

RESULTS

Three trajectories emerged: high probability of palpitations in perimenopause to early postmenopause diminishing in late postmenopause (15.9% of women), moderate probability of palpitations in perimenopause to early postmenopause diminishing in late postmenopause (34.3%), and sustained low probability of palpitations (49.8%). In the fully adjusted multivariable model, the high probability group had a more adverse reproductive and health-related profile at baseline (higher gravidity, early perimenopause, vasomotor symptoms, poorer overall health, higher depressive symptoms, higher perceived stress, greater sleep problems, higher blood pressure). In fully adjusted multivariable models, palpitation trajectories were not related to atherosclerosis or arterial stiffness.

CONCLUSIONS

Distinct patterns of palpitations emerged, with a substantial portion of women having palpitations during the perimenopause and early postmenopause. Palpitations were not associated with subclinical CVD. Findings can help identify women at risk of palpitations during the menopause transition who may need symptom relief.

Pregnancy loss is related to body mass index and prediabetes in early adulthood: Findings from Add Health

Pregnancy loss, including miscarriage and stillbirth, affects 15-20% of pregnancies in the United States (US) annually. Accumulating evidence suggests that pregnancy loss is associated with a greater cardiovascular disease (CVD) burden later in life. However, few studies have evaluated the impact of pregnancy loss on CVD risk factors in early adulthood (age <35 years). The aim of this study was to examine associations between pregnancy loss and CVD risk factors (body mass index, blood pressure, hyperlipidemia, diabetes status) in early adulthood. We conducted a cross-sectional analysis using the public-use dataset for Wave IV (2007-2009) of the National Longitudinal Study of Adolescent to Adult Health (Add Health). Our sample consisted of women, ages 24-32 years, with a previous pregnancy who completed biological data collection (n = 2,968). Pregnancy loss was assessed as any history of miscarriage or stillbirth; and quantified as none, one, or recurrent (≥2) pregnancy loss. Associations between pregnancy loss and each CVD risk factor were tested using linear and logistic regression adjusting for sociodemographic factors, parity, health behaviors during pregnancy, and depression. We tested for interactions with race/ethnicity. A total of 670 women reported a pregnancy loss, of which 28% reported recurrent pregnancy loss. A prior pregnancy loss was related to a 3.79 (kg/mm2) higher BMI in non-Hispanic Black women, but not white women. Women with recurrent pregnancy loss were more likely to have prediabetes (AOR, 1.93; 95% CI, 1.10-3.37, p<0.05) than women with all live births. Findings suggest that pregnancy loss may be associated with a more adverse CVD risk profile in early adulthood, particularly for women who experience recurrent pregnancy loss. This highlights the need for CVD risk assessment in young women with a prior pregnancy loss. Further research is necessary to identify underlying risk factors of pregnancy loss that may predispose women to CVD.

Psychosocial factors related to Cardiovascular Disease Risk in Young African American Women: a systematic review

OBJECTIVE

African American women are exposed to multiple adverse psychosocial factors, including racism, discrimination, poverty, neighborhood stress, anxiety, and depression. The impact of these psychosocial factors on cardiovascular disease (CVD) risk in women during early adulthood is limited. This review aims to summarize and synthesize the recent literature on psychosocial factors related to CVD risk in young African American women.

METHODS

We conducted a comprehensive search of the literature in PubMed, APA PsycINFO, and CINAHL. We systematically reviewed the literature for studies examining associations between psychosocial factors (e.g. racism, discrimination, neighborhood stress, anxiety) and CVD risk factors (e.g. body mass index [BMI], blood pressure, diabetes) in African American women age 19-24 years. Eligible studies measured at least one psychosocial factor, a CVD risk factor, and included young adult African American women (age 19-24) or reported sex-stratified analyses.

RESULTS

We identified nine studies that met our inclusion criteria: six cross-sectional and three longitudinal studies. Of these, eight studies reported that psychosocial factors (i.e. perceived stress, racial discrimination, internalized racism, depression) are related to higher BMI and blood pressure. The majority of studies were conducted among college students or had a small sample size (<200). The quality of six studies was rated as excellent; the remainder were good and fair.

CONCLUSIONS

Findings from this review suggest that exposure to adverse psychosocial factors may be related to increased CVD risk in early adulthood (age 19-24) in African American women. However, larger prospective analyses are necessary to examine these associations.

Lessons Learned in Clinical Research Recruitment of Midlife Latinas During COVID-19

OBJECTIVE

The purpose of this brief report is to describe lessons learned in recruiting and enrolling midlife Latinas in a pilot study to reduce cardiovascular disease (CVD) risk during the menopause transition. We also discuss strategies implemented to overcome the challenges presented by the novel coronavirus (COVID-19) pandemic.

METHODS

Menopausia, Salud y Corazo´n is a two-group (intervention, waitlist control), repeated measures study. The intervention consists of CVD risk education, coping skills training, physical activity, and stress management. Eligible participants are peri- and early postmenopausal Latinas age 40 to 60 years, free of CVD. From August 2020 to October 2021, we screened 110 women recruited from cultural events and health fairs (n = 56), local businesses (n = 24), and snowball sampling (n = 30). Of these, 60 were eligible for inclusion and 41 enrolled.

RESULTS

Strategies that contributed to successful recruitment included: a primarily Latina bilingual (English, Spanish) research team; flexibility with location and scheduling of data collection; and multiple modes of communication (ie, mailings, phone calls, and text messages). Additionally, we addressed Latino cultural values such as respeto (respect), familismo (loyalty to family), and confianza (trust). In response to COVID-19, we included virtual recruitment strategies, limited in-person visits, and distributed community resources for COVID-19.

CONCLUSION

We have found that despite the challenges presented by COVID-19, midlife Latinas are receptive to clinical research engagement. Researcher flexibility, multiple recruitment modalities, a bilingual research team, and communication strategies that address cultural values are essential elements for the representation of midlife Latinas in research.

Impact of COVID-19: A Text Mining Analysis of Twitter Data in Spanish Language

BACKGROUND

Latino communities in the United States and Latin America are disproportionately affected by the COVID-19 pandemic. We analyzed information shared on Twitter in Spanish language for insights into the public's communication and information needs about the COVID-19 pandemic.

METHODS

We performed a mixed-methods analysis using a text mining approach. We used SAS Text Miner, an algorithmic-driven statistical program to capture 10,000 tweets posted between June 3, 2020, and June 10, 2020. We used the following search terms to capture relevant Twitter messages in Spanish language: "coronavirus," "covid-19," "corona," and the hash tags "#COVID19" and "#Coronavirus." Key text topics were identified and categorized into themes using an emergent content analysis.

RESULTS

We identified 12 text topics and six themes: (1) prevention measures, (2) epidemiology/surveillance, (3) economic impact, (4) optimizing nursing workforce, (5) access to reliable information, and (6) call for a response from the local government. Top trending hashtags from our search included #COVID19 (n = 7,098), #Coronavirus (n = 6,394), and #SNTESALUD (n = 2,598).

CONCLUSIONS

Spanish-language Tweets related to the COVID-19 pandemic contained information from health departments and labor unions on the surveillance, prevention, and impact of COVID-19. Public health officials should consider increasing their use of Twitter to ensure a wide dissemination of messages about COVID-19 in Spanish outlets.

A multi-component, community-engaged intervention to reduce cardiovascular disease risk in perimenopausal Latinas: pilot study protocol

BACKGROUND

Cardiovascular disease (CVD) risk increases substantially during perimenopause. Latinas have a significantly worse CVD risk factor profile than non-Hispanic White women, potentially due to multiple sociocultural and environmental factors. To date, interdisciplinary interventions have not focused on improving nutrition, physical activity, stress management, and biologic CVD risk in perimenopausal Latinas. The purpose of this study is to examine the feasibility and initial efficacy of a multi-component intervention to reduce CVD risk in perimenopausal Latinas.

METHODS

This is a two-group, repeated measures experimental study. Eighty perimenopausal Latinas (age 40-55 years) from two community groups will be randomized: one group will complete the intervention; the other will be a wait-list control. The intervention consists of 12-weekly sessions (education, physical activity, stress management, coping skills training), followed by 3 months of continued support, and 6 months of skill maintenance on their own. The primary outcomes include arterial stiffness, blood pressure, lipids, and blood glucose. Secondary outcomes are health behaviors (nutrition, physical activity, sleep, coping strategies), self-efficacy, and other biological factors related to CVD risk (adiposity, C-reactive protein, hair cortisol, vasomotor symptoms). We will assess changes in outcomes from Time 1 (baseline) to Time 2 (6 months) and Time 3 (12 months) using general linear mixed models to test the hypotheses. We will also evaluate the feasibility of the intervention by assessing enrollment and retention rates, barriers, and facilitators to enrollment, intervention fidelity, the suitability of study procedures, and participant satisfaction with the intervention and study protocol. We hypothesize the intervention group will decrease biologic CVD risk and improve health behaviors and self-efficacy significantly more than the wait-list control.

DISCUSSION

Results from this study will contribute to knowledge on the feasibility of behavioral interventions, including stress management and coping skills training, which could reduce CVD burden among perimenopausal Latinas. Because Hispanic/Latinos are the largest ethnic minority in the United States (US), progress regarding CVD risk among perimenopausal Latinas may lead to significant improvement in the overall CVD burden in the US.

TRIAL REGISTRATION

Prospectively registered, NCT04313751 (03/19/2020), Protocol version 1.0.

Physiologic and psychosocial changes of the menopause transition in US Latinas: a narrative review

Latinos comprise the fastest-growing minority group in the USA, with Hispanic women (Latinas) constituting 17% of women aged 45-54 years. The menopause transition (MT) is associated with many physiological, behavioral, and psychosocial changes that can affect disease risk in women. While several epidemiologic investigations have enhanced our understanding of the MT, to date, menopause research has mostly focused on non-Latina White women. As a consequence, there is a dearth of information on strategies for managing menopause-related issues in Latinas and important factors to consider to provide culturally appropriate care and promote lifestyles that may reduce adverse health outcomes. This narrative review summarizes existing evidence of the MT in Latinas, with a focus on hormonal alterations, menopausal symptoms, mental health, cognition, and cardiometabolic health. The clinical and research implications of the current literature will also be discussed.

Associations of Endogenous Sex Hormones with Carotid Plaque Burden and Characteristics in Midlife Women

CONTEXT

Endogenous sex hormones may be involved in the pathogenesis of cardiovascular disease (CVD) in women. Carotid plaque characteristics, such as echogenicity, an ultrasound measure that reflects plaque composition, may identify unstable plaques that are more likely to rupture, precipitating a CVD event. However, few studies have considered sex steroids in relation to carotid plaque and its characteristics.

OBJECTIVE

To evaluate estrone (E1), estradiol (E2), testosterone (T), sex hormone binding globulin (SHBG), and free T (FT) in relation to carotid plaque in women.

DESIGN, SETTING, AND PARTICIPANTS

In MsHeart, a cross-sectional study of 304 women aged 40 to 60 years, participants underwent a carotid artery ultrasound assessment. The current analysis included MsHeart participants with carotid plaque (n = 141, 46%). E1, E2, and T were assayed using liquid chromatography-tandem mass spectrometry; FT was estimated using ensemble allostery models. Regression models were adjusted for sociodemographic characteristics and CVD risk factors.

MAIN OUTCOMES

Carotid plaque burden (number of plaques, total plaque area [TPA]) and characteristics (calcification, echogenicity) were determined using semi-automated software.

RESULTS

SHBG was inversely related to TPA (odds ratio [OR] 0.39; 95% confidence interval [CI] 0.21, 0.74; multivariable) and higher FTs were associated with greater TPA (OR 2.89; 95% CI 1.31, 6.37; multivariable). Higher E1 was related to echogenicity (OR 2.31; 95% CI 1.26, 4.33; multivariable), characteristic of more stable plaque.

CONCLUSIONS

SHBG and FT are related to TPA while E1 is related to plaque echogenicity, suggesting these hormones have different roles in the development of carotid plaque. Our findings highlight the importance of sex hormones in the development of carotid plaque in midlife women.

Pregnancy-related events associated with subclinical cardiovascular disease burden in late midlife: SWAN

BACKGROUND AND AIMS

Reproductive factors are associated with later life CVD in women (e.g., age at first birth, preeclampsia, gestational diabetes), but studies have focused largely on premenopausal women. We examined the relationship of reproductive factors with subclinical CVD burden in late midlife women.

METHODS

We included 964 parous women from the Study of Women's Health Across the Nation (SWAN), who completed a reproductive history questionnaire at the 13th SWAN visit (2011-2012), and a carotid ultrasound and brachial-ankle pulse wave velocity (baPWV) assessment. The primary outcomes were carotid intima-media thickness, plaque, and baPWV; our secondary outcome was a composite subclinical CVD index created using these measures. Linear and logistic regression was performed to examine associations with individual subclinical CVD measures, and multinomial logistic regression was used in analyses of the composite index. Models adjusted for socio-demographics and cardiovascular risk factors.

RESULTS

Mean age at subclinical CVD assessment was 60.2 years (SD ± 2.7). History of gestational hypertension/preeclampsia was associated with greater carotid IMT (β: 0.038, p = 0.004). Earlier age at first birth was associated with subclinical CVD, but not when accounting for CVD risk factors. History of gestational diabetes was associated with greater baPWV, but not related to our composite index.

CONCLUSIONS

Pregnancy history is an important marker of subclinical CVD in late midlife and may impact the vasculature through distinct pathways. Future studies are necessary to evaluate racial/ethnic differences in the observed associations and to assess the benefit of a composite subclinical CVD index for earlier CVD risk modification in midlife women.

Women's Reproductive History and Pre-Clinical Peripheral Arterial Disease in Late Life: The San Diego Population Study

Objective: Reproductive events have been linked with increased cardiovascular risk in women, but whether they are associated with pre-clinical peripheral arterial disease (PAD) has been understudied. We evaluated associations between reproductive factors and later-life ankle-brachial index (ABI), femoral artery intima-media thickness (fIMT), and femoral plaques. Methods: Cross-sectional analysis of 707 multiethnic women who participated in a follow-up exam of the San Diego Population Study in 2007-2011. To assess associations between reproductive factors (age at menarche, parity, age at menopause, surgical menopause, hormone therapy) with ABI, and Doppler ultrasound measurements of common and superficial fIMT, linear regression was used; for femoral plaque presence, logistic regression was used. Models were adjusted for age, race/ethnicity, and cardiometabolic factors. We tested interactions of reproductive factors with menopause type (natural vs. surgical). Results: Women were on average 71 years old, and 56% were non-Hispanic White. Reproductive factors were not associated with fIMT, femoral plaque presence, or ABI. There were significant interactions between menopause type (surgical vs. natural) and oral contraceptive use (-β: 0.04, p = 0.03) for ABI, as well as between menopause type and parity (β: 0.11, p = 0.05) and age at menopause (β: 0.001, p = 0.05) for fIMT. Among women with natural menopause, oral contraceptive use was associated with higher ABI (β: 0.03, p = 0.007) and older age at natural menopause was related to greater fIMT (β: 0.009, p = 0.06). Among women with surgical menopause, nulliparity was marginally associated with greater fIMT (β: 0.33, p = 0.07). Conclusions: Reproductive history may not be independently associated with later-life lower extremity atherosclerosis in women. Studies are necessary to confirm findings and examine pregnancy-related exposures in relation to pre-clinical PAD.

History of Adverse Pregnancy Outcomes, Blood Pressure, and Subclinical Vascular Measures in Late Midlife: SWAN (Study of Women's Health Across the Nation)

BACKGROUND

Adverse pregnancy outcomes, such as preterm birth (PTB), have been associated with elevated risk of maternal cardiovascular disease, but their effect on late midlife blood pressure (BP) and subclinical vascular measures remains understudied.

METHODS AND RESULTS

We conducted a cross-sectional analysis with 1220 multiethnic parous women enrolled in SWAN (Study of Women's Health Across the Nation) to evaluate the impact of self-reported history of adverse pregnancy outcomes (PTB, small-for-gestational-age, stillbirth), on maternal BP, mean arterial pressure, and subclinical vascular measures (carotid intima-media thickness, plaque, and pulse wave velocity) in late midlife. We also examined whether these associations were modified by race/ethnicity. Associations were tested in linear and logistic regression models adjusting for sociodemographics, reproductive factors, cardiovascular risk factors, and medications. Women were on average aged 60 years and 255 women reported a history of an adverse pregnancy outcome. In fully adjusted models, history of PTB was associated with higher BP (systolic: β=6.40; SE, 1.62 [P<0.0001] and diastolic: β=3.18; SE, 0.98 [P=0.001]) and mean arterial pressure (β=4.55; SE 1.13 [P<0.0001]). PTB was associated with lower intima-media thickness, but not after excluding women with prevalent hypertension. There were no significant associations with other subclinical vascular measures.

CONCLUSIONS

Findings suggest that history of PTB is associated with higher BP and mean arterial pressure in late midlife. Adverse pregnancy outcomes were not significantly related to subclinical cardiovascular disease when excluding women with prevalent hypertension. Future studies across the menopause transition may be important to assess the impact of adverse pregnancy outcomes on midlife progression of BP.

Urban-Dwelling Community Members' Views on Biomedical Research Engagement

In this study, we explore community members' overall understanding and experience with biomedical research engagement. We conducted a qualitative analysis to explore a concept that emerged but was not specifically addressed in a pre-existing dataset obtained using four focus group sessions with 30 urban-dwelling community members. Transcripts were read in an iterative process, and an emergent content analysis was performed. Five main themes were identified: (a) engaging in research to contribute to personal or greater good, (b) hierarchy of trust, (c) the importance of disclosure and transparency, (d) practical barriers to research engagement, and (e) fear of research procedures. Community members view research engagement as a collaborative process whereby community members and researchers are involved in all stages of the investigation. Focusing on research engagement, and not merely participation, may enhance community knowledge of the research process and advance scientific knowledge.

Cardiovascular Risk in HIV-Infected and Uninfected Postmenopausal Minority Women: Use of the Framingham Risk Score

OBJECTIVE

To characterize and compare cardiovascular disease (CVD) risk in HIV-infected and uninfected postmenopausal minority women using the Framingham Risk Score (FRS) as an assessment measure.

METHODS

A cross-sectional analysis was performed in 152 (109 HIV+, 43 HIV-) subjects from an existing study cohort of postmenopausal Hispanic and African American women. Data necessary to calculate FRS and menopause features were retrieved by retrospective chart review. Bivariate statistics was used to compare CVD risk factors. Multivariable linear regression was used to determine factors associated with FRS in HIV-infected women.

RESULTS

The HIV-infected group was younger, less obese, and with lower rates of diabetes versus controls. In a subset of age-matched participants, median FRS did not differ between groups (14.6 [IQR = 9.1, 21.6] vs. 15.5 [IQR = 12.3, 22.1]; p = 0.73). Fourteen percent of HIV-infected women meeting criteria for the low-risk FRS category (<10%) had a history of CVD, a similar rate as controls. HIV-infected women at intermediate/high CVD risk had higher rates of surgical menopause. According to 2013 clinical guidelines, more than half of HIV-infected women not prescribed statin therapy (52%) were eligible for treatment; however, statin therapy was similarly under-prescribed in uninfected women.

CONCLUSIONS

In this study, CVD risk as assessed by the FRS was not significantly different by HIV status. Performance of the FRS may be compromised in postmenopausal HIV-infected minority women. HIV-infected and uninfected women may be undertreated with statin therapy. Large longitudinal cohorts and inclusion of subclinical measures of CVD are necessary to better characterize risk.