Abstract #: 225
PREMENSTRUAL SYNDROME AND SUBSEQUENT HYPERTENSION IN A PROSPECTIVE STUDY. Elizabeth Bertone-Johnson*, Brian Whitcomb, Janet Rich-Edwards, Susan Hankinson, JoAnn Manson, (University of Massachusetts, Amherst MA United States)
While multiple studies have assessed how maternal pregnancy complications may predict future risk of hypertension and cardiovascular disease, few have evaluated how other aspects of reproductive health are associated with chronic disease risk. Up to 20% of premenopausal women meet clinical criteria for premenstrual syndrome (PMS), a disorder characterized by moderate to severe luteal phase symptoms that substantially interfere with normal life activities and interpersonal relationships. While the etiology of PMS remains largely unclear, many pathways underlying hypertension and cardiovascular disease are also implicated in the occurrence of PMS, including dysfunction of the renin-angiotensin-aldosterone system and vitamin D deficiency. We evaluated prospectively whether women experiencing PMS in their reproductive years had an elevated risk of subsequently developing hypertension. Participants were women enrolled in PMS Sub-Study of the Nurses’ Health Study II, and included 1257 women meeting established criteria for moderate-to-severe PMS and 2463 age-matched controls experiencing few menstrual symptoms. Follow-up for incident hypertension began at the time of PMS diagnosis or reference year (between 1993 and 2005) and continued until June, 2009. Over these 16 years, new diagnoses of hypertension were self-reported by 278 women with PMS and 418 women without PMS. After adjustment for age, smoking, body mass index, physical activity, DASH diet and other hypertension risk factors, women with PMS had a hazard ratio (HR) for incident hypertension of 1.50 (95% confidence interval(CI)=1.24–1.81) vs. women without PMS. The risk associated with PMS was highest for hypertension occurring before age 40 (HR=3.64; 95%CI=1.87–7.09). This is among the first studies to suggest that PMS may be an early sentinel of risk of hypertension. These observations warrant replication in other prospective studies.