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Cardiovascular risk factors and diseases in women undergoing hysterectomy with ovarian conservation

Laughlin-Tommaso, Shannon K. MD, MPH; Khan, Zaraq MBBS; Weaver, Amy L. MS; Schleck, Cathy D. BS; Rocca, Walter A. MD, MPH; Stewart, Elizabeth A. MD

doi: 10.1097/GME.0000000000000506
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Objective: This study aims to determine the association of preexisting cardiovascular risk factors and cardiovascular diseases with hysterectomy with bilateral ovarian conservation using a case-central design.

Methods: Using the Rochester Epidemiology Project records-linkage system, we identified all Olmsted County, MN women who underwent hysterectomy with ovarian conservation between January 1, 1965 and December 31, 2002 (cases). Each case was age-matched (±1 y) with a randomly selected woman who resided in the county and did not undergo hysterectomy or oophorectomy before the index date (date of hysterectomy in her matched case). Using electronic codes, we identified cardiovascular risk factors (diabetes, hypertension, hyperlipidemia, obesity, metabolic syndrome, and polycystic ovary syndrome) and cardiovascular diseases (coronary artery disease, congestive heart failure, myocardial infarction, and stroke) that occurred before the index date. Analyses were stratified by age at hysterectomy and indication for surgical operation.

Results: During the study period, 3,816 women underwent hysterectomy with ovarian conservation for a benign indication. Preexisting hyperlipidemia, obesity, and metabolic syndrome were significantly more frequent in cases than in controls in univariable analyses. In multivariable analyses, obesity remained significantly associated overall, for nearly all age groups, and across all indications. Stroke was significantly more frequent in cases than in controls among women younger than 36 years. Congestive heart failure and stroke were significantly less common in cases than in controls among women older than 50 years.

Conclusions: Hysterectomy with ovarian conservation is associated with cardiovascular risk factors, particularly obesity. Obesity may contribute to underlying gynecologic conditions leading to hysterectomy; however, surgical selection may also play a role.

1Division of Gynecology, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN

2Department of Surgery, Mayo Clinic, Rochester, MN

3Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN

4Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN

5Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN

6Department of Neurology, College of Medicine, Mayo Clinic, Rochester, MN.

Address correspondence to: Shannon K. Laughlin-Tommaso, MD, MPH, Division of Gynecology, Department of Obstetrics and Gynecology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905. E-mail: laughlintommaso.shannon@mayo.edu

Received 2 December, 2014

Revised 7 May, 2015

Accepted 7 May, 2015

Funding/support: This study was funded by the Office of Research on Women's Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development (grants RC1 HD063312 and R01 HD060503), Building Interdisciplinary Research Careers in Women's Health (grant K12HD065987), and National Institute on Aging (grants R01 AG034676 and P50 AG044170).

Financial disclosure/conflicts of interest: None reported.

© 2016 by The North American Menopause Society.