Risk of cardiovascular disease by hysterectomy status, with and without oophorectomy - The Women's Health Initiative Observational Study
Risk of cardiovascular disease by hysterectomy status, with and without oophorectomy - The Women's Health Initiative Observational Study
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DOI：
10.1161/01.cir.0000159344.21672.fd
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发表时间：
2005-03-29
期刊：
影响因子：
37.8
通讯作者：
Trevisan, M
中科院分区：
文献类型：
--
作者：
Howard, BV;Kuller, L;Trevisan, M
背景-心血管疾病(CVD)是女性发病率和死亡率的主要原因，并可能因子宫切除(或卵巢切除)状态而异。这项研究比较了绝经后子宫切除、卵巢切除和未切除的绝经后妇女的心血管疾病危险因素和发生率。方法和结果--这项分析是在妇女健康倡议(WHI)观察性研究中对89914名妇女进行的。参与者报告了人口统计特征、病史、饮食习惯、体力活动、药物治疗和既往子宫切除术(有或没有卵巢切除术)。测量基线体重、身高、腰围和血压。心血管事件在平均随访5.1年期间被确定，并根据标准标准进行判定。黑人、西班牙裔和美国印第安人女性的子宫切除率高于白人女性(分别为52.9%、44.6%和49.2%对40.0%)，而亚洲/太平洋岛民女性的子宫切除率较低(33.8%)。与未切除子宫的妇女相比，接受子宫切除的妇女(无论卵巢切除状况如何)在基线时具有不利的风险，包括高血压、糖尿病、高胆固醇、肥胖的比例较高，以及较低的教育、收入和体力活动(均P<；0.01)。在接受子宫切除术的妇女中，总死亡率、致命性和非致命性心血管疾病的发生率较高。子宫切除(与卵巢切除状态无关)是心血管疾病的重要预测因子(HR：1.26，P<；0.001)。在调整了人口统计学变量和心血管疾病危险因素后，影响减小且不显著。结论：在该队列中，接受子宫切除术的女性的风险状况较差，心血管疾病的患病率和发病率较高。多变量模型表明，子宫切除术不是这一结果的主要决定因素；相反，心血管疾病风险可能是由于接受子宫切除术的女性的初始风险更不利。
Background - Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in women and may vary by hysterectomy ( or oophorectomy) status. This study compared CVD risk factors and rates between postmenopausal women who had and had not undergone hysterectomy, with or without oophorectomy.Methods and Results - This analysis was conducted on 89 914 women in the Women's Health Initiative (WHI) Observational Study. Participants reported demographic characteristics, medical history, dietary habits, physical activity, medications, and previous hysterectomy ( with or without oophorectomy). Baseline weight, height, waist circumference, and blood pressure were measured. CVD events were ascertained during 5.1 years of mean follow-up and adjudicated with standard criteria. Black, Hispanic, and American Indian women had higher rates of hysterectomy than white women (52.9%, 44.6%, and 49.2% versus 40.0%, respectively), and Asian/Pacific Islander women had lower rates (33.8%). Women with a hysterectomy ( regardless of oophorectomy status) had an adverse risk profile at baseline compared with women with no hysterectomy, including a higher proportion of hypertension, diabetes, high cholesterol, obesity, and lower education, income, and physical activity ( all P < 0.01). Total mortality and fatal and nonfatal CVD were higher among women with a hysterectomy. Hysterectomy ( regardless of oophorectomy status) was a significant predictor of CVD (HR: 1.26, P < 0.001). After adjustment for demographic variables and CVD risk factors, the effect was reduced and nonsignificant.Conclusions - Women with a hysterectomy had a worse risk profile and higher prevalence and incidence of CVD in this cohort. Multivariate models suggest that hysterectomy is not the major determinant of this outcome; rather, CVD risk may be due to the more adverse initial risk profile of women who had undergone hysterectomy.