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Oophorectomy does not reduce link between CVD, diabetes in postmenopausal women
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In postmenopausal women with type 2 diabetes, bilateral salpingo oophorectomy does not appear to mitigate the association between diabetes and cardiovascular disease, implying that this association may not be primarily driven by hyperandrogenemia, according to recent findings.
In the study, Duke Appiah, MPH, PhD, of the University of Minnesota, and colleagues analyzed data from 7,977 women (mean age at baseline, 71.5 years) enrolled in the Study of Osteoporotic Fractures to determine whether a history of bilateral salpingo oophorectomy is negatively associated with CVD mortality in women with type 2 diabetes.
A random subset of women from the study who were not taking hormone therapy (n = 564) had available sex-steroid hormone measurements. The women were followed for a mean 15.1 years.
Overall, 6.3% of participants reported a history of diabetes and 18% reported a history of bilateral salpingo oophorectomy.
Sex-hormone levels were found to be significantly affected by ovarian status and diabetes. Participants with diabetes had lower sex-hormone binding globulin (SHBG; P < .001) and higher free testosterone (P = .026) compared with those without diabetes, independent of age and BMI. Participants with diabetes and intact ovaries had higher estrone levels compared with participants without diabetes (P < .001). Compared with participants with intact ovaries, those who underwent bilateral salpingo oophorectomy had lower total testosterone and free testosterone (P < .001 for both). An association was found between bilateral salpingo oophorectomy and lower SHBG levels for participants with diabetes but higher SHBG levels for participants without diabetes (P = .001).
Through follow-up there were 4,797 deaths with 34.1% attributed to CVD with the following for the CVD-related death rates per 1,000 based on diabetes and bilateral salpingo oophorectomy status: neither, 12.9; bilateral salpingo oophorectomy without diabetes, 12.7; diabetes without bilateral salpingo oophorectomy, 25.9; and both, 31.4.
Participants with diabetes had a higher prevalence of CVD mortality, with or without bilateral salpingo oophorectomy (P < .001). The CVD mortality risk in participants with diabetes was increased in those with intact ovaries (HR = 1.95; 95% CI, 1.62-2.35) and for those who had undergone bilateral salpingo oophorectomy (HR = 2.56; 95% CI, 1.79-3.65). Although participants with diabetes and bilateral salpingo oophorectomy had a slightly higher prevalence of CVD mortality compared with those without intact ovaries, it was not statistically significant. CVD mortality and bilateral salpingo oophorectomy were not associated (HR = 1.05; 95% CI, 0.89-1.23).
In an age-stratified analysis, an elevated adjusted risk for CVD mortality was found among women with diabetes who underwent bilateral salpingo oophorectomy at or before age 45 years.
“These results warrant further investigations among younger women with diabetes and [bilateral salpingo oophorectomy] to determine if this risk is due to [bilateral salpingo oophorectomy] or is a marker for risk factors that could be associated with PCOS,” the researchers wrote. – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.
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