Risk of Cardiovascular Disease by Hysterectomy Status, With and Without Oophorectomy

Abstract

Background-Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in women and may vary by hysterectomy (or oophorectomy) status. This study compared CVD risk factors and rates between postmenopausal women who had and had not undergone hysterectomy, with or without oophorectomy. Methods and Results-This analysis was conducted on 89 914 women in the Women's Health Initiative (WHI) Observational Study. Participants reported demographic characteristics, medical history, dietary habits, physical activity, medications, and previous hysterectomy (with or without oophorectomy). Baseline weight, height, waist circumference, and blood pressure were measured. CVD events were ascertained during 5.1 years of mean follow-up and adjudicated with standard criteria. Black, Hispanic, and American Indian women had higher rates of hysterectomy than white women (52.9%, 44.6%, and 49.2% versus 40.0%, respectively), and Asian/Pacific Islander women had lower rates (33.8%). Women with a hysterectomy (regardless of oophorectomy status) had an adverse risk profile at baseline compared with women with no hysterectomy, including a higher proportion of hypertension, diabetes, high cholesterol, obesity, and lower education, income, and physical activity (all PϽ0.01). Total mortality and fatal and nonfatal CVD were higher among women with a hysterectomy. Hysterectomy (regardless of oophorectomy status) was a significant predictor of CVD (HR: 1.26, PϽ0.001). After adjustment for demographic variables and CVD risk factors, the effect was reduced and nonsignificant. Conclusions-Women with a hysterectomy had a worse risk profile and higher prevalence and incidence of CVD in this cohort.Multivariate models suggest that hysterectomy is not the major determinant of this outcome; rather, CVD risk may be due to the more adverse initial risk profile of women who had undergone hysterectomy.

Metabolic syndrome after risk-reducing salpingo-oophorectomy in women at high risk for hereditary breast ovarian cancer: A controlled observational study

“…Howard et al (151) performed sub analyses of the Women's Health Initiative (WHI) material. The authors found that hysterectomy with or without oophorectomy was significantly associated with CVD, but that the association was non-significant after adjustments for CVD risk factors at baseline (smoking, hypertension, diabetes, high cholesterol, history of peripheral artery disease, and history of deep vein thrombosis).…”

Trends in Endometrial Cancer Incidence by Race and Histology with a Correction for the Prevalence of Hysterectomy, SEER 1992 to 2008

“…From 2000 to 2004, the rate of hysterectomy in the United States was highest among women age 40 to 49 and varied by region with the highest rates found in the South and the lowest in the Northeast. Moreover, the proportion of women who have had a hysterectomy (referred to as "hysterectomy prevalence" in this article), varies by race and is highest among black women (14)(15)(16)(17)(18). Women who have had a hysterectomy are no longer at risk of endometrial cancer and failure to remove these women from the population at-risk leads to an underestimate of endometrial cancer incidence rates (15,(19)(20)(21)(22)(23)(24) and an incorrect estimate of the difference in incidence among various population groups.…”

Factores de riesgo para la enfermedad coronaria temprana en mujeres

“…Syndrome Evaluation (WISE) (5) y el Women's Health Initiative (WHI) (6), plantean la presencia de un modelo de riesgo cardiovascular multifactorial en la mujer, que involucra la interacción de los factores hormonales con los factores tradicionales y los factores condicionales, explicando la aparición de enfermedad coronaria (4).…”

“…Todos estos factores han sido evaluados en poblaciones de mujeres mayores de 66 años con enfermedad coronaria (9,16) pero, hasta el momento, se desconoce su importancia en el grupo de mujeres menores de 55 años que desarrolla enfermedad coronaria temprana (6). Estudios como el Coronary Artery Surgery Study (CASS) (16) reportan una incidencia de 7% de enfermedad coronaria en las mujeres menores de 55 años, por lo que existen aún elementos no identificados en el perfil de riesgo cardiovascular de las mujeres que se encuentran en la premenopausia y los años iniciales de la menopausia.…”