Appiah Duke, Winters Stephen J, Allison Matthew A, Baumgartner Richard N, Groves Frank D, Myers John A, Hornung Carlton A
Department of Epidemiology and Population Health, University of Louisville, Louisville, KY 40202, United States.
Division of Endocrinology, Metabolism and Diabetes, University of Louisville, Louisville, KY 40202, United States.
Diabetes Res Clin Pract. 2015 Jun;108(3):473-81. doi: 10.1016/j.diabres.2015.02.017. Epub 2015 Feb 25.
Women with type-2 diabetes (DM2) are at high risk of cardiovascular disease (CVD) which may be partly due to increased ovarian androgen production. Since the association of bilateral oophorectomy (BSO) with CVD remains controversial, we evaluated whether BSO is inversely associated with CVD among DM2.
Data were obtained from a national sample of 9599 postmenopausal women. Adjusted estimates and 95% confidence intervals (CIs) were calculated using logistic and Cox regression.
At baseline 2426 women had type-2 diabetes, of whom 580 had BSO. DM2 had adverse CVD risk profiles compared to women without diabetes, as did women with BSO with or without diabetes compared to those with intact ovaries. In DM2, BSO was positively associated with prevalent CVD (odds ratio: 1.63, 95%CI: 1.16-2.30). However, the higher odds were limited to women who had BSO before age 45 years (OR: 2.11, CI: 1.45-3.08). During a mean follow-up of 12.7 years, BSO in DM2 was positively associated with CVD mortality (hazard ratio: 2.23, CI: 1.25-3.99). Among women with BSO, those with family members who had MI before age 50 had elevated odds of CVD (OR: 2.29, CI: 1.56-3.37) compared to those without such family history (OR: 0.90, CI: 0.67-1.20), Pinteraction=0.04.
The risk of CVD is increased not decreased with BSO in DM2. Further, we propose that the association of BSO and CVD in young women with diabetes may partly reflect genetic susceptibility to CVD rather than an effect of ovarian hormones.
2型糖尿病（DM2）女性患心血管疾病（CVD）的风险较高，这可能部分归因于卵巢雄激素分泌增加。由于双侧卵巢切除术（BSO）与CVD之间的关联仍存在争议，我们评估了在DM2患者中BSO是否与CVD呈负相关。
数据来自全国9599名绝经后女性样本。使用逻辑回归和Cox回归计算校正估计值和95%置信区间（CI）。
基线时，2426名女性患有2型糖尿病，其中580名接受了BSO。与无糖尿病女性相比，DM2患者具有不良的CVD风险特征，与卵巢完整的女性相比，接受BSO的女性（无论是否患有糖尿病）也是如此。在DM2患者中，BSO与CVD患病率呈正相关（优势比：1.63，95%CI：1.16 - 2.30）。然而，较高的优势比仅限于45岁之前接受BSO的女性（OR：2.11，CI：1.45 - 3.08）。在平均12.7年的随访期间，DM2患者中的BSO与CVD死亡率呈正相关（风险比：2.23，CI：1.25 - 3.99）。在接受BSO的女性中，与没有此类家族史的女性（OR：0.90，CI：0.67 - 1.20）相比，有50岁之前患心肌梗死家庭成员的女性患CVD的几率更高（OR：2.29，CI：1.56 - 3.37），P交互作用 = 0.04。
在DM2患者中，BSO会增加而非降低CVD风险。此外，我们认为年轻糖尿病女性中BSO与CVD之间的关联可能部分反映了对CVD的遗传易感性，而非卵巢激素的作用。
