Hot flash severity may predict metabolic-associated liver disease

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Key takeaways:

  • There is an association between hot flash severity and metabolic dysfunction-associated steatotic liver disease.
  • Women with troublesome vasomotor symptoms should receive a cardiovascular risk evaluation.

BOSTON — Midlife women reporting bothersome hot flashes are more likely to receive a diagnosis of metabolic dysfunction-associated steatotic liver disease regardless of hormone therapy use, according to a speaker.

Reproductive aging is associated with the accumulation of cardiometabolic risk factors but also progressively increasing risk for cardiovascular disease, Eleni Armeni, MD, PhD, MSc, of the 2nd department of obstetrics and gynecology at National and Kapodistrian University of Athens, Greece, said during a presentation at ENDO 2024. Metabolic dysfunction-associated steatotic liver disease (MASLD) is also linked to higher CVD risk; however, more research is needed on the prevalence of MASLD and any association with vasomotor symptoms, Armeni said.

There is an association between hot flash severity and metabolic dysfunction-associated steatotic liver disease. Image: Adobe Stock.

“At this point, it is important to remember what was known all along — that menopausal aging can be linked with insulin resistance, higher rates of type 2 diabetes and CVD, but this risk also reflects on the liver function,” Armeni said. “When a [menopausal] woman comes to your clinic, a holistic assessment should include assessment of the liver and CV risk.”

For the cross-sectional study, researchers evaluated 106 peri- and postmenopausal women from an outpatient university menopause clinic in Athens, Greece. Researchers estimated the extent of steatotic liver disease via the fatty liver index; a score of 60 or greater is an established cutoff for MASLD.

Eleni Armeni

MASLD was defined as the presence of one or more of the following risk factors observed in women with hepatic steatosis: BMI of 25 kg/m2 or higher or waist circumference 85 cm or greater; fasting glucose of 100 mg/dL or higher or type 2 diabetes; blood pressure of 130/85 mm Hg or higher or antihypertensive treatment; triglycerides of 150 mg/ dL or higher or related treatment; and HDL cholesterol of 40 mg/dL or lower or lipid-lowering treatment. Severity of vasomotor symptoms was assessed using the Greene Climacteric Scale.

Within the cohort, 42 women had moderate to severe vasomotor symptoms and 64 women had no to mild vasomotor symptoms; 17.1% of women had MASLD and 82.9% had normal liver function. Women with MASLD were more likely to have overweight or obesity, Armeni said.

Compared with no to mild hot flashes, moderate to severe vasomotor symptoms were associated with a threefold greater risk for MASLD (OR = 3.022; P = .041). When researchers restricted the analyses to early postmenopausal women within 5 years of their final menstrual period, those reporting moderate to severe hot flashes were at ninefold greater risk for MASLD compared with those reporting few or no symptoms (OR = 9.333; P = .045). Results persisted after adjusting for age, physical activity, alcohol consumption, smoking, history of menstrual irregularity and HT use.

Women with MASLD were also more likely to report moderate to severe vasomotor symptoms compared with women without MASLD (57.9% vs. 35.6%; OR = 1.738; P = .041).

“The association between vasomotor symptom severity and MASLD is present regardless of use of hormone replacement therapy,” Armeni said. “It is important to assess for CV risk when evaluating women experiencing troublesome vasomotor symptoms.”

During a Q&A after the presentation, Armeni said the researchers plan to conduct sonographic assessments of the liver to ensure the findings are correct.

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