Changes in CV Risk Factors by Hysterectomy Status
Changes in CV Risk Factors by Hysterectomy Status
Compared with the women who were excluded from the analysis, women in the analytic sample were older (46.3 ± 2.6 years vs. mean 45.2 ± 2.7 years, p < 0.001), more educated (46.5% vs. 37.3% college or post-college, p < 0.001), reported better self-rated health (61.3% vs. 52.6% excellent/very good health, p < 0.001), had higher HDL-C (61.0 ± 16.5 vs. mean 54.7 ± 16.0, p < 0.001), and had lower BMI (28.0 ± 7.3 vs. 28.8 ± 7.1, p < 0.01), HOMA-IR scores (3.3 ± 4.0 vs. 5.0 ± 7.0, p < 0.01 on the basis of logged values), and SBP (117.8 ± 17.3 vs. 124.0 ± 15.6, p < 0.001) at baseline. Of the 183 women in the 2 surgery groups, 140 had documented medical records with regard to diagnosis. The most common preoperative symptoms and diagnoses in the available medical records were suspected or diagnosed uterine fibroids (75.7%), suspected or diagnosed menorrhagia (58.6%), and chronic pelvic pain (25.7%). Suspected or diagnosed fibroids accompanied the presentation of menorrhagia (85.4%) and chronic pelvic pain (83.3%) in this sample.
Participants were followed for up to 11 years after study entry, with observations from up to 9 years before and after FMP or surgery and a mean ± SD number of exams/woman being 10.78 ± 0.90, with 4.71 ± 2.33 on average after FMP or surgery. On average women reported HT use after FMP or surgery at 0.72 ± 1.58, 1.22 ± 1.75, and 3.42 ± 2.97 visits for natural menopause, hysterectomy with ovarian conservation, and hysterectomy with bilateral oophorectomy groups, respectively (p < 0.001). The proportion of visits on HT throughout the study before and after FMP or surgery for these groups were, on average, 0.14 ± 0.34, 0.22 ± 0.29, and 0.57 ± 0.36, p < 0.001.
Women who subsequently reported hysterectomy with or without oophorectomy were more likely to be African-American and younger (Table 1). The tPA-ag levels were elevated at study entry among women who later had hysterectomy with bilateral oophorectomy, whereas BMI, Factor VIIc levels, and use of lipid-lowering medications were higher at study entry among women who later had hysterectomy with ovarian conservation, as compared with women with naturally occurring menopause. No other risk factors differed by FMP/surgery status.
At the time of the index visit, women with hysterectomy with ovarian conservation had higher LDL-C and tended to have higher ApoB levels (which was significant when adjusted for BMI), whereas women with hysterectomy with bilateral oophorectomy had higher triglyceride levels, relative to the natural post-menopausal women (Table 2) Figure 1 shows the covariate-adjusted means (95% confidence intervals) on the basis of predicted values from linear regression models within each year.) The LDL-C, triglycerides, and ApoA1 levels increased annually before and after FMP, whereas HDL-C decreased annually after FMP. The ApoB increased before FMP and nonsignificantly declined after FMP. The change in these factors was similar before and after surgery compared with before and after FMP, with 2 exceptions. The increase in ApoA1 levels was larger, with a modest decline in triglyceride levels before surgery in women with hysterectomy with ovarian conservation, compared with those who became naturally post-menopausal. Further adjustments for BMI did not alter the results.
(Enlarge Image)
Figure 1.
Lipids Annual Means
Covariate-adjusted means (95% confidence interval) at the time of surgery and before and after surgery compared with values at the time of final menstrual period (FMP) and before and after FMP on the basis of predicted values from adjusted linear regression models within each year. Slopes before and after surgery compared with slopes before and after FMP were identical, except for a steeper slope for ApoA1 before having hysterectomy with ovarian conservation (p = 0.03). Abbreviations as in Table 1.
At the index visit, groups did not differ in HOMA-IR, SBP, tPA-ag, Factor VIIc, or CRP levels (Table 3). From study entry to FMP, women increased annually in SBP, tPA-ag, and Factor VIIc and declined annually in PAI-1 and CRP. These changes were similar to those experienced by women from baseline to surgery, except that tPA-ag decreased annually in women who had a hysterectomy with ovarian conservation, and CRP levels increased annually more in the women who subsequently had a hysterectomy with bilateral oophorectomy (Table 3. After FMP, HOMA-IR increased annually, and PAI-1 declined. After surgery the changes were similar to those experienced by the natural menopause group.
Further adjustments for BMI did alter the results somewhat for tPA-ag and CRP: after FMP, tPA-ag increased annually (estimate [SE] = 0.74 [0.35] p = 0.04), whereas it declined annually after either hysterectomy with ovarian conservation (estimate = −0.14 [0.43], p = 0.04) or after hysterectomy with bilateral oophorectomy (estimate = −0.13 [0.47], p = 0.06). The CRP levels after hysterectomy with ovarian conservation declined annually (estimate = −0.24 [0.17], p = 0.04), relative to after FMP (estimate = 0.11 [0.08]).
There were no significant effects of ethnicity and change in CV risk factors before and after FMP or surgery. In other words, the impact of hysterectomy with or without oophorectomy in relation to FMP did not differ between African Americans and Caucasians.
Results
Characteristics of Analytic Sample
Compared with the women who were excluded from the analysis, women in the analytic sample were older (46.3 ± 2.6 years vs. mean 45.2 ± 2.7 years, p < 0.001), more educated (46.5% vs. 37.3% college or post-college, p < 0.001), reported better self-rated health (61.3% vs. 52.6% excellent/very good health, p < 0.001), had higher HDL-C (61.0 ± 16.5 vs. mean 54.7 ± 16.0, p < 0.001), and had lower BMI (28.0 ± 7.3 vs. 28.8 ± 7.1, p < 0.01), HOMA-IR scores (3.3 ± 4.0 vs. 5.0 ± 7.0, p < 0.01 on the basis of logged values), and SBP (117.8 ± 17.3 vs. 124.0 ± 15.6, p < 0.001) at baseline. Of the 183 women in the 2 surgery groups, 140 had documented medical records with regard to diagnosis. The most common preoperative symptoms and diagnoses in the available medical records were suspected or diagnosed uterine fibroids (75.7%), suspected or diagnosed menorrhagia (58.6%), and chronic pelvic pain (25.7%). Suspected or diagnosed fibroids accompanied the presentation of menorrhagia (85.4%) and chronic pelvic pain (83.3%) in this sample.
Participants were followed for up to 11 years after study entry, with observations from up to 9 years before and after FMP or surgery and a mean ± SD number of exams/woman being 10.78 ± 0.90, with 4.71 ± 2.33 on average after FMP or surgery. On average women reported HT use after FMP or surgery at 0.72 ± 1.58, 1.22 ± 1.75, and 3.42 ± 2.97 visits for natural menopause, hysterectomy with ovarian conservation, and hysterectomy with bilateral oophorectomy groups, respectively (p < 0.001). The proportion of visits on HT throughout the study before and after FMP or surgery for these groups were, on average, 0.14 ± 0.34, 0.22 ± 0.29, and 0.57 ± 0.36, p < 0.001.
Women who subsequently reported hysterectomy with or without oophorectomy were more likely to be African-American and younger (Table 1). The tPA-ag levels were elevated at study entry among women who later had hysterectomy with bilateral oophorectomy, whereas BMI, Factor VIIc levels, and use of lipid-lowering medications were higher at study entry among women who later had hysterectomy with ovarian conservation, as compared with women with naturally occurring menopause. No other risk factors differed by FMP/surgery status.
Lipid Changes
At the time of the index visit, women with hysterectomy with ovarian conservation had higher LDL-C and tended to have higher ApoB levels (which was significant when adjusted for BMI), whereas women with hysterectomy with bilateral oophorectomy had higher triglyceride levels, relative to the natural post-menopausal women (Table 2) Figure 1 shows the covariate-adjusted means (95% confidence intervals) on the basis of predicted values from linear regression models within each year.) The LDL-C, triglycerides, and ApoA1 levels increased annually before and after FMP, whereas HDL-C decreased annually after FMP. The ApoB increased before FMP and nonsignificantly declined after FMP. The change in these factors was similar before and after surgery compared with before and after FMP, with 2 exceptions. The increase in ApoA1 levels was larger, with a modest decline in triglyceride levels before surgery in women with hysterectomy with ovarian conservation, compared with those who became naturally post-menopausal. Further adjustments for BMI did not alter the results.
(Enlarge Image)
Figure 1.
Lipids Annual Means
Covariate-adjusted means (95% confidence interval) at the time of surgery and before and after surgery compared with values at the time of final menstrual period (FMP) and before and after FMP on the basis of predicted values from adjusted linear regression models within each year. Slopes before and after surgery compared with slopes before and after FMP were identical, except for a steeper slope for ApoA1 before having hysterectomy with ovarian conservation (p = 0.03). Abbreviations as in Table 1.
Other Cardiovascular Risk Factors
At the index visit, groups did not differ in HOMA-IR, SBP, tPA-ag, Factor VIIc, or CRP levels (Table 3). From study entry to FMP, women increased annually in SBP, tPA-ag, and Factor VIIc and declined annually in PAI-1 and CRP. These changes were similar to those experienced by women from baseline to surgery, except that tPA-ag decreased annually in women who had a hysterectomy with ovarian conservation, and CRP levels increased annually more in the women who subsequently had a hysterectomy with bilateral oophorectomy (Table 3. After FMP, HOMA-IR increased annually, and PAI-1 declined. After surgery the changes were similar to those experienced by the natural menopause group.
Further adjustments for BMI did alter the results somewhat for tPA-ag and CRP: after FMP, tPA-ag increased annually (estimate [SE] = 0.74 [0.35] p = 0.04), whereas it declined annually after either hysterectomy with ovarian conservation (estimate = −0.14 [0.43], p = 0.04) or after hysterectomy with bilateral oophorectomy (estimate = −0.13 [0.47], p = 0.06). The CRP levels after hysterectomy with ovarian conservation declined annually (estimate = −0.24 [0.17], p = 0.04), relative to after FMP (estimate = 0.11 [0.08]).
There were no significant effects of ethnicity and change in CV risk factors before and after FMP or surgery. In other words, the impact of hysterectomy with or without oophorectomy in relation to FMP did not differ between African Americans and Caucasians.
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