Associations between Hysterectomy and Metabolic Syndrome: The Multi-Ethnic Study of Atherosclerosis

Eric K Broni; Justin B Echouffo Tcheugui; Anna Palatnik; Ernest M Graham; Ruth-Alma Turkson-Ocran; Yvonne Commodore-Mendah; Chiadi E Ndumele; Erin D Michos

doi:10.1016/j.ajog.2024.04.035

Associations between Hysterectomy and Metabolic Syndrome: The Multi-Ethnic Study of Atherosclerosis

Am J Obstet Gynecol. 2024 May 2:S0002-9378(24)00561-1. doi: 10.1016/j.ajog.2024.04.035. Online ahead of print.

Authors

Eric K Broni¹, Justin B Echouffo Tcheugui², Anna Palatnik³, Ernest M Graham⁴, Ruth-Alma Turkson-Ocran⁵, Yvonne Commodore-Mendah⁶, Chiadi E Ndumele¹, Erin D Michos⁷

Affiliations

¹ Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD.
² Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, MD.
³ Division of Maternal-Fetal medicine, Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI.
⁴ Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Johns Hopkins University, Baltimore, MD.
⁵ General Medicine, Research; Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
⁶ Johns Hopkins University School of Nursing, Baltimore, MD.
⁷ Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: edonnell@jhmi.edu.

PMID: 38703940
DOI: 10.1016/j.ajog.2024.04.035

Abstract

Background: Metabolic syndrome is linked to an increased risk of incident cardiovascular disease (CVD) and all-cause mortality. Notable associations exist between hysterectomy with bilateral salpingo-oophorectomy and metabolic syndrome. However, there is emerging evidence that even with ovarian conservation, hysterectomy may be independently associated with long-term CVD risk.

Objective: To examine the associations between hysterectomy with ovarian preservation and metabolic syndrome risk in a multi-ethnic cohort.

Methods: We studied 3,367 female participants in the Multi-Ethnic Study of Atherosclerosis who had data on self-reported history of hysterectomy, oophorectomy, hystero-oophorectomy and metabolic syndrome at baseline (2000-2002). We used adjusted logistic regression to assess the cross-sectional associations between hysterectomy/oophorectomy subgroups and prevalent metabolic syndrome at baseline. Furthermore, we investigated 1,355 participants free of baseline metabolic syndrome and used adjusted Cox regression models to evaluate incident metabolic syndrome from exams 2 (2002-2004) to 6 (2016-2018).

Results: The mean±SD age was 59.0±9.5 years, with 42% White, 27% Black, 19% Hispanic, and 13% Chinese American participants. 29% and 22% had a history of hysterectomy and oophorectomy, respectively. Over a median follow-up period of 10.5 (3.01-17.62) years, there were 750 metabolic syndrome events. Hysterectomy [HR, 1.32 (95%CI, 1.01-1.73)] and hystero-oophorectomy [1.40 (1.13-1.74)] were both strongly associated with incident metabolic syndrome compared to having neither hysterectomy or oophorectomy.

Conclusion: Hysterectomy, even with ovarian preservation, may be independently associated with a higher risk of metabolic syndrome. If other studies confirm these findings, screening and preventive strategies focused on females with ovary-sparing hysterectomy and the mechanisms underpinning these associations may be explored.

Keywords: Hysterectomy; hystero-oophorectomy; metabolic syndrome; ovarian conservation; ovary-sparing hysterectomy.