Subclinical Atherosclerosis in Relation to Hysterectomy Status in Black Women

Abstract

Background and Purpose-This study was designed to investigate whether black women who underwent hysterectomy only (nϭ59) or hysterectomy plus bilateral oophorectomy (nϭ25) were at increased risk of subclinical carotid atherosclerosis compared with black women who underwent natural menopause (nϭ54). The effects of both surgery and menopausal status were evaluated. Methods-Women aged 34 to 58 years were recruited from the Pittsburgh, Pa, area. Postmenopausal status was defined as a serum follicle-stimulating hormone level of Ͼ30 mIU/mL. Carotid duplex scans were performed to assess the degree of focal plaque. Results-Among premenopausal women, focal plaque was present in 20% of nonhysterectomized versus 49% of hysterectomized-only women (Pϭ.004). Among postmenopausal women, plaque was present in 69% of nonhysterectomized women, 86% of women with hysterectomy only, and 48% of women with oophorectomy and hysterectomy (Pϭ.056). Among postmenopausal women, hormone replacement therapy was used by 23% of women who had undergone natural menopause, 0% of women with hysterectomy only, and 36% of women with oophorectomy and hysterectomy. The prevalence of plaque was 33% among hormone replacement therapy users versus 73% among nonusers (Pϭ.014). In multivariate analysis, independent associations with the presence of at least 1 plaque were postmenopausal status and hysterectomy only. Conclusions-These data suggest that black women who undergo hysterectomy without oophorectomy may be at higher risk of subclinical carotid atherosclerosis than black women who undergo natural menopause or hysterectomy plus oophorectomy. (Stroke. 1998;29:759-764.)

Cardiovascular and metabolic morbidity after hysterectomy with ovarian conservation: a cohort study

“…Two studies have shown that women who had undergone hysterectomy with ovarian conservation were equally or less likely to be using hormone therapy than women with bilateral oophorectomy or women without hysterectomy. 28,29 We did not have complete information concerning the use of hormonal therapy after the index date. This information was not available electronically in the REP until 1998.…”

The Association between Subclinical Atherosclerosis and Uterine Fibroids

“…African-American women have been reported to have 2–3 times the risk of UF than White women [6], [13], a difference that could not be explained by ethnic differences in hormone levels and other known risks [3], [6]. In comparison with White women, Black women have a higher prevalence of hypertension, diabetes and obesity [14], which are independently associated with UF [12], [15], [16]. These factors are also common cardiovascular risks and might be related to atherosclerosis [17].…”

Hormone replacement therapy in the prevention and treatment of atherosclerosis

“…Increases in prothrombotic factors and markers of platelet dysfunction also returned to prehysterectomy levels. In premenopausal black women, focal carotid plaque was found to be present in 20% of subjects compared with 48% of hysterectomy patients [11]. Among postmenopausal women, plaque was present in 73% of nonusers, but present only in 33% of women on HRT.…”