Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, USA.
Department of Obstetrics and Gynecology, Kuwait University, Kuwait City, Kuwait.
Minerva Obstet Gynecol. 2023 Feb;75(1):27-38. doi: 10.23736/S2724-606X.22.04952-1. Epub 2022 Mar 25.
Emerging evidence suggests that cardiometabolic risk factors contribute to uterine leiomyoma development, but cardiometabolic profiles of women with the tumor remain poorly defined. This study aimed to determine the association of cardiometabolic comorbidities and cardiometabolic medication use with a leiomyoma diagnosis.
In this cross-sectional study, aggregate-level data from 2013-2020 were collected using the SlicerDicer feature of Epic (Epic, Verona, WI, USA) electronic medical record system. Women ≥18 years with at least one visit or hospital encounter at the Johns Hopkins Health System (N.=679,981) were assigned as cases or controls according to leiomyoma status. Individual prevalence of each prespecified cardiometabolic comorbidity and relevant prescription medications was obtained. Prevalence Odds Ratios were used to assess the association of cardiometabolic comorbidities and medication use with uterine leiomyoma.
Women with uterine leiomyoma (N.=27,703) were more likely to be obese (2.56; 95% CI: 2.49-2.63), have metabolic syndrome (1.82; 95% CI: 1.51-2.19), essential hypertension (1.45; 95% CI: 1.42-1.49), diabetes mellitus (1.29; 95% CI: 1.24-1.33) and hyperlipidemia (1.23; 95% CI: 1.19-1.26). These associations were stronger among younger women and persisted after excluding those with a hysterectomy. Notably, statins were the only medications associated with a lower leiomyoma risk (0.81; 95% CI: 0.79-0.84).
Uterine leiomyoma is associated with a spectrum of cardiometabolic comorbidities and use of associated medications, constituting an unfavorable cardiometabolic profile in women with the tumor. If definitively correlated, prevention and early management of cardiometabolic risk factors may decrease uterine leiomyoma incidence, and screening women with uterine leiomyoma for cardiometabolic comorbidities may aid in cardiovascular disease prevention.
新出现的证据表明，心脏代谢危险因素与子宫肌瘤的发生有关，但肿瘤患者的心脏代谢特征仍未得到明确界定。本研究旨在确定心脏代谢合并症和心脏代谢药物的使用与子宫肌瘤诊断之间的关联。
在这项横断面研究中，使用 Epic（Epic，Verona，WI，USA）电子病历系统的 SlicerDicer 功能，从 2013 年至 2020 年收集汇总数据。符合以下条件的女性≥18 岁，且在约翰霍普金斯卫生系统（Johns Hopkins Health System）至少有一次就诊或住院经历（N=679,981），根据子宫肌瘤的情况，被分配为病例或对照组。获得每个预先规定的心脏代谢合并症和相关处方药物的个体患病率。使用患病率比值比（Prevalence Odds Ratio）来评估心脏代谢合并症和药物使用与子宫平滑肌瘤的关联。
患有子宫肌瘤的女性（N=27,703）更有可能肥胖（2.56；95%置信区间：2.49-2.63）、患有代谢综合征（1.82；95%置信区间：1.51-2.19）、原发性高血压（1.45；95%置信区间：1.42-1.49）、糖尿病（1.29；95%置信区间：1.24-1.33）和血脂异常（1.23；95%置信区间：1.19-1.26）。这些关联在年轻女性中更为明显，且在排除子宫切除术患者后仍然存在。值得注意的是，他汀类药物是唯一与较低的子宫肌瘤风险相关的药物（0.81；95%置信区间：0.79-0.84）。
子宫肌瘤与一系列心脏代谢合并症和相关药物的使用有关，构成了肿瘤患者不良的心脏代谢特征。如果能明确相关性，预防和早期管理心脏代谢危险因素可能会降低子宫肌瘤的发生率，对患有子宫肌瘤的女性进行心脏代谢合并症筛查可能有助于预防心血管疾病。
