Oophorectomy as a risk factor for coronary heart disease

Abstract

Objective-To examine the relationship between bilateral oophorectomy (BSO) and risk of coronary heart disease (CHD).Study Design-We searched PubMed, EMBASE, meeting abstracts, and reference lists for studies that compared women with BSO at the time of hysterectomy to 1) women with hysterectomy and ovarian conservation, 2) naturally menopausal women, 3) premenopausal women or, 4) women with no history of hysterectomy or BSO but unreported menopausal status. The primary outcome was fatal or nonfatal CHD.Results-We reviewed 1,956 citations. Seven observational studies met inclusion criteria. Heterogeneity among studies precluded formal meta-analysis. Four studies reported BSO increases risk for CHD but only in some subgroups of women or not in fully adjusted multivariate models. Three studies found no increased risk of CHD following BSO but these studies had significant limitations. Conclusion-The existing evidence is inconclusive to determine the effect of BSO on risk of CHD.

Síndrome metabólica e menopausa: estudo transversal em ambulatório de ginecologia

“…A recent review in California that linked surgical menopause with cardiovascular risk failed to allow the desired meta-analysis due to the heterogeneity of the results found, also due to methodological errors of the studies 30 .…”

Removal of normal ovaries in women under age 51 at the time of hysterectomy

“…7,18,19 A more recent 2013 study found no difference in change in cardiovascular disease (CVD) risk factors among women with or without premenopausal BSO at the time of hysterectomy, 20 and reviews have found the literature to be inconclusive. 21,22 In our model, a history of cardiovascular disease did not affect oophorectomy. This could indicate that these prior findings have not impacted clinical practice of oophorectomy, or that continued conflicting data has led clinicians to discount this information.…”

Cardiovascular disease among diabetic women with bilateral oophorectomy.

“…In our view, several methodological limitations exist among studies conducted to demonstrate whether there is an association between BSO and CVD (58). Notably, women who undergo hysterectomy (regardless of ovarian status) have adverse CVD risk profile compared to those without hysterectomy (57), and a number of studies have failed to control for these factors.…”

“…But bilateral oophorectomy eliminates ovarian hormones, and might be expected to influence CAD risk. Women who undergo hysterectomy (regardless of oophorectomy status) have an adverse CVD risk profile compared to those without hysterectomy, and BSO is linked to increasing CVD risk in some (41,(50)(51)(52)(53)(54) but not all studies (55)(56)(57)(58)(59). However, the increased CVD risk among women with BSO is limited to women who have the procedure before the average age at natural menopause (or an arbitrary age of 45 years) and those not receiving hormone therapy (51)(52)(53)(54).…”

“…In our spline regression analyses, oophorectomy at the time of hysterectomy in premenopausal women was associated with adverse cardiovascular health in both diabetic and non-diabetic women even when postmenopausal hormone use is taken into account. The mechanism by which oophorectomy elevates cardiovascular disease risk in both diabetic and non-diabetic women may be related to an adverse cardiovascular risk profile among women who undergo this surgical procedure (57)(58)(59). The abrupt cessation of ovarian function as a consequence of bilateral oophorectomy resulting in decreased endogenous estrogens is suggested to adversely influence lipid profiles in premenopausal women, although this has not been consistent across all studies (190).…”