Associations between hysterectomy and metabolic syndrome: the Multi-Ethnic Study of Atherosclerosis - 30/05/24
Abstract |
Background |
Metabolic syndrome is linked to an increased risk of incident cardiovascular disease and all-cause mortality. Notable associations exist between hysterectomy with bilateral salpingo-oophorectomy and metabolic syndrome. However, there is emerging evidence that even with ovarian conservation, hysterectomy may be independently associated with long-term cardiovascular disease risk.
Objective |
To examine the associations between hysterectomy with ovarian preservation and metabolic syndrome risk in a multiethnic cohort.
Study Design |
We studied 3367 female participants in the Multi-Ethnic Study of Atherosclerosis who had data on self-reported history of hysterectomy, oophorectomy, hystero-oophorectomy, and metabolic syndrome at baseline (2000–2002). We used adjusted logistic regression to assess the cross-sectional associations between hysterectomy and or oophorectomy subgroups and prevalent metabolic syndrome at baseline. Furthermore, we investigated 1355 participants free of baseline metabolic syndrome and used adjusted Cox regression models to evaluate incident metabolic syndrome from examinations 2 (2002–2004) to 6 (2016–2018).
Results |
The mean age was 59.0±9.5 years, with 42% White, 27% Black, 19% Hispanic, and 13% Chinese American participants. 29% and 22% had a history of hysterectomy and oophorectomy, respectively. Over a median follow-up of 10.5 (3.01–17.62) years, there were 750 metabolic syndrome events. Hysterectomy (hazard ratio, 1.32 [95% confidence interval, 1.01–1.73]) and hystero-oophorectomy (hazard ratio, 1.40 [95% confidence interval, 1.13–1.74]) were both associated with incident metabolic syndrome compared with having neither hysterectomy nor oophorectomy.
Conclusion |
Hysterectomy, even with ovarian preservation, may be independently associated with a higher risk of metabolic syndrome. If other studies confirm these findings, screening and preventive strategies focused on females with ovary-sparing hysterectomies and the mechanisms underpinning these associations may be explored.
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Key words : hysterectomy, hystero-oophorectomy, metabolic syndrome, ovarian conservation, ovary-sparing hysterectomy
Plan
Unrelated to this work, E.D.M. has served as a consultant for Amgen, AstraZeneca, Boehringer Ingelheim, Edwards Life Science, Esperion, Medtronic, Merck, Novartis, Novo Nordisk, and Pfizer. None of the other authors report any conflicts of interest. |
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Multi-Ethnic Study of Atherosclerosis is an observational study, not a clinical trial, but it is registered at clinicaltrials.gov NCT00005487. |
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The Multi-Ethnic Study of Atherosclerosis was supported by contracts HHSN268201500003I, N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168, and N01-HC-95169 from the National Heart, Lung and Blood Institute and by grants UL1-TR-000040, UL1-TR-001079 and UL1-TR-001420 from National Center for Advancing Translational Sciences. |
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E.D.M. is supported by the American Heart Association (award no. 946222) and Amato Fund in Women’s Cardiovascular Health research at Johns Hopkins University. E.K.B. is supported by an American Heart Association diversity supplement (award no. 874772). C.E.N. and E.D.M. are supported for this work by an American Heart Association Strategic Focused Research Network Grant (no. 20SFRN35120152). |
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Because of patient identifiers and protected health information, there are restrictions on sharing the actual Multi-Ethnic Study of Atherosclerosis (MESA) database. Therefore, the availability of the datasets presented in this article are subject to Institutional Review Board approval. We have signed a data use agreement with the MESA Coordinating Center stating that we cannot directly share data and that anyone with access to the data must follow MESA policies and procedures for data use. The data are securely stored in the Cloud using encrypted software for protection. However, other researchers may obtain the minimal dataset required to replicate our study findings by submitting a proposal through the National Institutes of Health BioLINCC (mesa/). In addition, researcher(s) can apply to the MESA Coordinating Center to become new investigator(s) after signing a DUA. The findings of this study should be easily reproducible through the methods described. Requests to access the datasets should be directed to Craig Johnson (wcraigj@uw.edu) at the MESA Coordinating Center or www.mesa-nhlbi.org/. |
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Cite this article as: Broni EK, Echouffo-Tcheugui JB, Palatnik A, et al. Associations between hysterectomy and metabolic syndrome: the multiethnic study of atherosclerosis. Am J Obstet Gynecol 2024;XX:x.ex–x.ex. |
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