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Original research
Risk of cardiovascular disease after preventive salpingo-oophorectomy
  1. Nora Johansen1,2,
  2. Serena Tonstad3,
  3. Astrid Helene Liavaag1,
  4. Randi Marie Selmer4,
  5. Tom Gunnar Tanbo5 and
  6. Trond Melbye Michelsen6
  1. 1 Obstetrics and Gynecology, Sørlandet Hospital Arendal, Arendal, Norway
  2. 2 University of Oslo Faculty of Medicine, Oslo, Norway
  3. 3 Department of Preventive Cardiology, Oslo University Hospital, Oslo, Norway
  4. 4 Norwegian Institute of Public Health, Oslo, Norway
  5. 5 Department of Reproductive Medicine, Oslo University Hospital, Oslo, Norway
  6. 6 Department of Obstetrics, Division of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway
  1. Correspondence to Dr Nora Johansen, Obstetrics and Gynecology, Sorlandet Hospital Arendahl, Arendal 0424, Norway; nora.johansen{at}sshf.no

Abstract

Introduction Breast cancer susceptibility gene (BRCA) mutation carriers are recommended to undergo early oophorectomy to prevent ovarian cancer. Premature loss of ovarian hormones may increase the risk of cardiovascular disease. Because women with preventive oophorectomy are mainly young and healthy, they rarely undergo specialized cardiological surveillance. We compared the risk of cardiovascular disease in women after preventive oophorectomy with reference women.

Methods In an historical cohort study, we included 134 women aged ≤52 years after preventive oophorectomy and 268 age matched premenopausal reference women, aged 52 years or less, from the general population, excluding participants with diabetes or cardiovascular disease. The Norwegian risk assessment tool (NORRISK 2) was used to estimate 10 year cardiovascular risk. This algorithm was validated in a large Norwegian population and is based on age, smoking, systolic blood pressure, total and high density lipoprotein cholesterol, antihypertensive medication, and family history of cardiovascular disease. We also examined cardiometabolic factors (levels of triglycerides and high sensitivity C reactive protein, as well as body mass index and waist circumference) not included in the NORRISK 2 calculation.

Results Median age in the preventive oophorectomy and reference groups were 47 (range 33–52) and 46 (31–52) years, respectively. Mean time since surgery in the preventive oophorectomy group was 4.2 years (standard deviation (SD) 2.8). Ten year cardiovascular risk was similar in women after preventive oophorectomy and reference women (mean 1.15% (SD 1.00) vs 1.25 (1.09), respectively, p=0.4). Women in the preventive oophorectomy group had a lower body mass index (24.7 kg/m2 (4.0) vs 26.2 (4.8), p=0.003) and waist circumference (86 cm vs 89, p=0.006). The overall cardiovascular risk estimation was comparable among hormone therapy users and non-users, but hormone therapy users had lower total cholesterol and waist circumference.

Discussion Women who underwent preventive oophorectomy had a similar risk of cardiovascular disease as population based reference women, estimated according to risk factors easily measured in general practice. Cardiometabolic risks were not increased in the preventive oophorectomy group.

  • gynecology

https://doi.org/10.1136/ijgc-2019-000856

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    Footnotes

    • Contributors TMM and AHL conceived and designed the study. TMM collected the data, and all authors analyzed and interpreted the data. NJ, ST, AHL, and TMM drafted the manuscript, and all authors revised the manuscript critically for intellectual content and approved the final version. All authors agreed to be accountable for all aspects of the work ensuring integrity and accuracy.

    • Funding The Norwegian Women’s Public Health Association, the Research Unit at Sørlandet Hospital HF, and the South-Eastern Norway Regional Health Authority funded the work.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The study was approved by the Regional Committee for Medical and Health Research Ethics of South East Norway in September 2012 (REK No 2012/1165).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request as deidentified participant data.