早期子宫切除术与韩国女性心血管疾病风险的关联。

Association of Early Hysterectomy With Risk of Cardiovascular Disease in Korean Women.

机构信息

Department of Obstetrics and Gynecology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea.

Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea.

出版信息

JAMA Netw Open. 2023 Jun 1;6(6):e2317145. doi: 10.1001/jamanetworkopen.2023.17145.

DOI:10.1001/jamanetworkopen.2023.17145

PMID:37307002

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10261994/

Abstract

IMPORTANCE

Women who undergo surgical hysterectomy before natural menopause may have an earlier increase in hematocrit and storage iron levels than those who continue menstruation, thereby increasing the risk of cardiovascular disease (CVD) at ages younger than usually seen. Examining this issue may provide important implications for women's cardiovascular health to both physicians and patients.

OBJECTIVE

To evaluate the association of hysterectomy with the risk of incident CVD among women before age 50 years.

DESIGN, SETTING, AND PARTICIPANTS: In this Korean population-based cohort study, 135 575 women aged 40 to 49 years were evaluated from January 1, 2011, to December 31, 2014. After propensity score matching in covariates including age, socioeconomic status, region, Charlson Comorbidity Index, hypertension, diabetes, dyslipidemia, menopause, menopausal hormone therapy, and adnexal surgery before inclusion, 55 539 pairs were included in the hysterectomy and nonhysterectomy groups. Participants were followed up until December 31, 2020. Data analysis was conducted from December 20, 2021, to February 17, 2022.

MAIN OUTCOMES AND MEASURES

The primary outcome was an incidental CVD, a composite of myocardial infarction, coronary artery revascularization, and stroke. The individual components of the primary outcome were also evaluated.

RESULTS

A total of 55 539 pairs were included; median age in the combined groups was 45 (IQR, 42-47) years. During median follow-up periods in the hysterectomy group of 7.9 (IQR, 6.8-8.9) years and nonhysterectomy group of 7.9 (IQR, 6.8-8.8) years, the incidence of CVD was 115 per 100 000 person-years for the hysterectomy group and 96 per 100 000 person-years for the nonhysterectomy group. After adjusting for confounding factors, the hysterectomy group had an increased risk of CVD compared with the nonhysterectomy group (hazard ratio [HR], 1.25; 95% CI, 1.09-1.44). The incidences of myocardial infarction and coronary artery revascularization were comparable between the groups, whereas the risk of stroke was significantly higher in the hysterectomy group (HR, 1.31; 95% CI, 1.12-1.53). Even after excluding women who underwent oophorectomy, the hysterectomy group had higher risks of CVD (HR, 1.24; 95% CI, 1.06-1.44).

CONCLUSIONS AND RELEVANCE

The findings of this cohort study suggest early menopause owing to hysterectomy was associated with increased risks for a composite of CVD, particularly stroke.

摘要

重要性

绝经前接受子宫切除术的女性与继续月经的女性相比，其血细胞比容和储存铁水平可能更早增加，从而使心血管疾病 (CVD) 的发病风险在通常所见的年龄之前增加。研究这个问题可能对医生和患者都对女性的心血管健康具有重要意义。

目的

评估子宫切除术与 50 岁以下女性 CVD 发病风险之间的关联。

设计、设置和参与者：在这项基于韩国人群的队列研究中，评估了 2011 年 1 月 1 日至 2014 年 12 月 31 日期间年龄在 40 至 49 岁的 135575 名女性。在包括年龄、社会经济地位、地区、Charlson 合并症指数、高血压、糖尿病、血脂异常、绝经、绝经激素治疗和纳入前附件手术在内的协变量中进行倾向评分匹配后，纳入了 55539 对子宫切除术和非子宫切除术组。参与者随访至 2020 年 12 月 31 日。数据分析于 2021 年 12 月 20 日至 2022 年 2 月 17 日进行。

主要结果和测量

主要结局是意外 CVD，即心肌梗死、冠状动脉血运重建和中风的综合结果。还评估了主要结局的各个组成部分。

结果

共纳入 55539 对；合并组的中位年龄为 45 岁（四分位距[IQR]，42-47）岁。在子宫切除术组的中位随访期为 7.9 年（IQR，6.8-8.9）和非子宫切除术组的 7.9 年（IQR，6.8-8.8）中，子宫切除术组的 CVD 发病率为每 100000 人年 115 例，非子宫切除术组为每 100000 人年 96 例。在调整混杂因素后，与非子宫切除术组相比，子宫切除术组发生 CVD 的风险增加（风险比[HR]，1.25；95%CI，1.09-1.44）。两组心肌梗死和冠状动脉血运重建的发生率相当，而子宫切除术组中风的风险明显更高（HR，1.31；95%CI，1.12-1.53）。即使排除接受卵巢切除术的女性，子宫切除术组的 CVD 风险仍然更高（HR，1.24；95%CI，1.06-1.44）。