Family MI history raises mortality risk in women undergoing bilateral oophorectomy
Women aged 45 years or younger who undergo bilateral oophorectomy and report having a first-degree relative who experienced premature myocardial infarction are at greater risk for cardiovascular death or death from any cause when compared with women without either condition, according to findings published in Menopause.
“Among women without family history of premature MI, no significant elevated risk for heart disease, CVD and all-cause mortality was observed among women with bilateral salpingo-oophorectomy regardless of age at surgery,” Duke Appiah, PhD, MPH, assistant professor and MPH program director in the department of public health at Texas Tech University Health Sciences Center, and colleagues wrote in the study background. “These novel findings, which extend prior results, suggest that family history of premature MI may play an important role in the relation of bilateral salpingo-oophorectomy occurring at an early age with the incidence of cardiovascular outcomes, and provides new insights into the longstanding controversy surrounding bilateral salpingo-oophorectomy and CVD events.”
Appiah and colleagues analyzed data from 2,763 postmenopausal women aged at least 40 years who participated in the National Health and Nutrition Examination Survey between 1988 and 1994 and were followed through December 2015 (mean baseline age, 62 years). Participants reported in home interviews whether a first-degree relative had an MI before age 50 years; oophorectomy status was also obtained via interview. Researchers used Cox regression analysis to estimate adjusted HRs for mortality due to heart disease, mortality due to CVD and all-cause mortality. Heart disease was defined as acute rheumatic fever and chronic rheumatic heart diseases, hypertensive heart disease, hypertensive heart and renal disease, and ischemic heart disease. CVD mortality was defined as deaths from heart disease or cerebrovascular disease.
Within the cohort, 610 women underwent bilateral salpingo-oophorectomy, 338 women had a family history of premature MI, and 95 women underwent bilateral salpingo-oophorectomy and had a family history of premature MI.
During a median follow-up of 22 years, 1,713 women died, with 395 deaths attributed to heart disease and 542 deaths attributed to CVD.
Overall, researchers did not observe an association between bilateral oophorectomy and heart disease, CVD or all-cause mortality; however, women who underwent oophorectomy before age 45 years were more likely to die of heart disease (HR = 1.6; 95% CI, 1.18-2.16), CVD (HR = 1.44; 95% CI, 1.12-1.85) and all-cause mortality (HR = 1.31; 95% CI, 1.16-1.48).
In adjusted models, women who underwent bilateral oophorectomy before age 45 years with a family history of premature MI had an approximately threefold risk for heart disease mortality, a twofold risk for CVD mortality and a 58% elevated risk for all-cause mortality, according to the researchers. Compared with women who underwent bilateral oophorectomy after age 45 years, HRs for women who underwent oophorectomy before age 45 years were 4.32 for death due to heart disease (95% CI, 1.95-9.5), 3.21 for death due to CVD (95% CI, 1.52-6.8) and 1.75 for all-cause mortality (95% CI, 1.28-2.41).
“Among women without a family history of premature MI, no significant differences in the risk for heart disease, CVD and all-cause mortality were observed by age at bilateral salpingo-oophorectomy,” the researchers wrote.
“According to the American College of Obstetricians and Gynecologists, strong consideration should be given for retaining normal ovaries in premenopausal women who are not at increased genetic risk of ovarian cancer,” the researchers wrote. “Our results underscore the need to also consider family history of premature MI in the decision to perform prophylactic oophorectomy in young women.” – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.
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Appiah D, et al. Menopause. 2020;doi:10.1097/GME.0000000000001522.
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