CVD risk reduction from treatment of hot flushes

Inspired by Palma et al 2020.[1]

CVD – cardiovascular disease

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Those readers who attended the BMAS Autumn meeting in 2019 may remember some of the details from the paper I am highlighting this week. Professor Angelo Cagnacci gave us a great presentation on his recently published research, and then finished with some bonus pre-publication data. This is the publication of that data.

HRT – hormone replacement therapy

I invited him to present a comparative 3-arm trial of acupuncture, phytoestrogens and low dose HRT on climacteric symptoms,[2] which he did, but then he added the data on CVD risk reduction.[1] That is the thing I like most about conferences, you get the latest data, and often a year or more before it is in print.

I highlighted the original paper on this blog because despite being rather small (n=75 in 3 parallel arms),[2] it was a little different from the usual open or sham controlled trials in the acupuncture literature, since it is not common to see a comparison of 3 treatments for a condition. The results of this first trial showed that acupuncture was superior to phytoestrogens and similar to HRT for reduction in the Greene climacteric score.[3] For more details see: Hot flushes 2 2019.

Prof Angelo laid out the background, which is that the menopause is associated with an acceleration of late-onset chronic disease, and that this process appears to be worse in women who suffer more severe climacteric symptoms. In such women lipid and glucose metabolism is worse, oxidative stress is higher and blood pressure (BP) is likely to be elevated. All of these factors could be associated with the acceleration of chronic disease, and in particular CVD risk.

This paper reported the changes in CVD risk factors from the original trial. Outcomes were BP, serum lipids and HOMA-IR (a measure of insulin resistance). BP dropped considerably in the acupuncture and phytoestrogen groups but not in the HT group. LDL cholesterol dropped in the phytoestrogen group only.

The BP drop with acupuncture was 7–8 mmHg

The BP drop associated with acupuncture (12 weekly treatments) and phytoestrogens (oral soy isoflavones 75mg bd) after 12 weeks of treatment was 7–8 mmHg, whereas there was no change in the HRT group. The Cochrane review on acupuncture in hypertension from 2018 found evidence of very low certainty from 4 trials with a total of 386 patients for a drop in systolic BP of 3.4 mmHg and diastolic BP of 2.0 mmHg.[4]

So, if we consider both papers from Prof Angelo’s group, it looks as though acupuncture has a similar effect on climacteric symptoms to low dose HRT, but a bigger effect on cardiovascular risk factors. Standard dose HRT has been shown to modify CVD risk factors and subsequent events,[5,6] but we cannot assume that acupuncture will automatically do the same, although all the large retrospective cohorts highlighted on this blog would tend to suggest it might.

Reference list

1         Palma F, Fontanesi F, Neri I, et al. Blood pressure and cardiovascular risk factors in women treated for climacteric symptoms with acupuncture, phytoestrogens, or hormones. Menopause Published Online First: 17 August 2020. doi:10.1097/GME.0000000000001626

2         Palma F, Fontanesi F, Facchinetti F, et al. Acupuncture or phy(F)itoestrogens vs. (E)strogen plus progestin on menopausal symptoms. A randomized study. Gynecol Endocrinol 2019;0:1–4. doi:10.1080/09513590.2019.1621835

3         Greene J. Constructing a standard climacteric scale. Maturitas 1998;29:25–31. doi:10.1016/S0378-5122(98)00025-5

4         Yang J, Chen J, Yang M, et al. Acupuncture for hypertension. Cochrane Database Syst Rev 2018;11:CD008821. doi:10.1002/14651858.CD008821.pub2

5         Cagnacci A, Cannoletta M. Modification of blood pressure in postmenopausal women: role of hormone replacement therapy. Int J Womens Health 2014;6:745. doi:10.2147/IJWH.S61685

6         Baber RJ, Panay N, Fenton A. 2016 IMS Recommendations on women’s midlife health and menopause hormone therapy. Climacteric 2016;19:109–50. doi:10.3109/13697137.2015.1129166

Declaration of interests MC