Changes in Cardiovascular Risk Factors by Hysterectomy Status With and Without Oophorectomy: Study of Women’s Health Across the Nation

Study Questions:

Do cardiovascular disease (CVD) risk factors change after hysterectomy (with or without bilateral oophorectomy) compared to changes in CVD risk factors related to natural menopause?

Methods:

Data from the SWAN (Study of Women’s Health Across the Nation) study were used for the present analysis. SWAN enrolled 3,302 premenopausal women not using hormone therapy between the ages of 42-52 years of age, and followed them annually for over 11 years for sociodemographic characteristics, menopausal status, surgeries, body mass index, medication use, lifestyle factors, lipids, blood pressure, insulin resistance, and hemostatic and inflammatory factors.

Results:

By 2008, 1,769 women had reached natural menopause, 77 women had a hysterectomy with ovarian conservation, and 106 women had a hysterectomy with bilateral oophorectomy. The influence of natural and hysterectomy with or without ovarian conservation was similar for high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, apolipoprotein B (ApoB), homeostasis model of assessment-insulin resistance, systolic blood pressure, plasminogen activator inhibitor type 1, and factor VIIc over time. Several CVD risk factor changes did differ during the intervals prior to and following hysterectomy, compared to the changes prior to and following final menstrual period (FMP), but not in a pattern suggesting increasing CV risk following hysterectomy. Prior to hysterectomy with ovarian conservation, triglycerides and tissue plasminogen activator (t-PA) changes declined and ApoA increased, compared to the changes prior to natural menopause, suggesting a lower risk trajectory among these women presurgically. Prior to hysterectomy with bilateral oophorectomy, C-reactive protein increases were greater than prior to a natural menopause, but no differences occurred after surgery, compared to after FMP. Multivariable analyses showed that annual changes in CVD risk factors did not vary by group with few exceptions, and the significant group differences that did emerge were not in the anticipated direction.

Conclusions:

The investigators concluded that women who underwent hysterectomy with or without ovarian conservation did not have significant changes in CVD risk factor status after elective surgery in mid-life compared to women undergoing natural menopause.

Perspective:

These data suggest that hysterectomy with or without bilateral oophorectomy is not associated with increased CV risk.

Clinical Topics: Arrhythmias and Clinical EP, Diabetes and Cardiometabolic Disease, Dyslipidemia, Atrial Fibrillation/Supraventricular Arrhythmias, Hypertriglyceridemia, Lipid Metabolism, Nonstatins

Keywords: Plasminogen Activator Inhibitor 1, Women's Health, Ovariectomy, Risk Factors, Blood Pressure, Insulin Resistance, Hemostasis, Menopause, Cholesterol, Surgical Procedures, Elective, C-Reactive Protein, Body Mass Index, Cardiovascular Diseases, Hysterectomy, Atrial Fibrillation, Premenopause, Homeostasis, Tissue Plasminogen Activator, Triglycerides, Atrial Flutter


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