Hysterectomy is associated with large artery stiffening in estrogen-deficient postmenopausal women

Abstract

Objective: Hysterectomy, with or without oophorectomy, is associated with increased cardiovascular disease (CVD) risk due, in part, to an adverse CVD risk factor profile. Large artery stiffening, a biomarker of vascular aging, increases the risk for CVD. We determined whether hysterectomy with or without bilateral oophorectomy (BLO) is associated with arterial stiffening in healthy postmenopausal women.

Methods: We conducted a cross-sectional study including estrogen-deficient postmenopausal women who had a hysterectomy with ovarian preservation (n = 24; mean ± SE age, 59 ± 1 y) or with BLO (n = 21; 58 ± 2 y) and had no hysterectomy/no BLO (n = 58; 58 ± 1 y). Arterial stiffness (arterial compliance and β stiffness index) was measured by ultrasonography of the carotid artery.

Results: Carotid artery compliance was lower in women with hysterectomy alone and in women with hysterectomy with BLO compared with women with no hysterectomy (0.66 ± 0.03 and 0.71 ± 0.06 vs 0.89 ± 0.03 mm/mm Hg × 10, respectively, both P < 0.05). There were no differences in traditional CVD risk factors (ie, adiposity, blood pressure and fasted lipids and lipoproteins, glucose, and insulin) between the groups. After adjustment for age, menopause duration, previous menopausal hormone therapy duration, parity, waist-to-hip ratio, systolic blood pressure, and sex hormone-binding globulin, hysterectomy status remained a significant predictor of arterial compliance.

Conclusions: These results indicate that hysterectomy status (with or without BLO) is associated with greater arterial stiffening in estrogen-deficient postmenopausal women. The greater arterial stiffening with hysterectomy was not related to an adverse CVD risk profile. Large artery stiffening may be an important mechanism by which hysterectomy increases the risk of CVD in postmenopausal women.

Figures

Figure 1

Baseline carotid artery compliance (top) and beta stiffness index (bottom) in postmenopausal women with no hysterectomy (open bar; n=58), hysterectomy alone (grey bar; n=24) and hysterectomy with bilateral oophorectomy (black bar; n=21). *P

Figure 2

Carotid artery compliance in postmenopausal women with no hysterectomy (open circles), hysterectomy alone (closed triangles upside down) and hysterectomy with bilateral oophorectomy (gray triangles). Regression lines represent relation between age and carotid artery compliance in each group.