NEWS & PERSPECTIVE
Hysterectomy-induced menopause linked to a higher risk of CVD and stroke among Korean women
In general, postmenopausal women experience elevated risks of coronary artery disease and stroke, causing an increase in cardiovascular disease (CVD)-related morbidity and mortality in this population.1 The loss of menstruation after hysterectomy may result in hemorheologic deleterious effect, leading to an elevated blood viscosity, further promoting endothelial injury, rupture of plaques, and thrombus formation.1 As such, women who received hysterectomy before natural menopause, theoretically, are also likely to be at an elevated risk of CVD, since they may experience an earlier increase in hematocrit and storage iron levels.1
The intricate relationship between hysterectomy and the associated risk of CVD in women has been well documented in the literature.2,3 For instance, a population-based cohort study conducted in the United States (US) found that an increased long-term risk of CVD was associated with women who underwent hysterectomy without oophorectomy.2 Meanwhile, another Taiwanese population-based cohort study had somewhat contradicting results, indicating that the elevated risks of coronary heart disease, CVD and stroke were only prevalent among premenopausal women aged <45 years who underwent hysterectomy, while no significant difference in the CVD risk was observed among postmenopausal women aged ≥45 years, regardless of receiving any hysterectomy treatment.3 Hence, there is a need for more population-based analysis to determine the association between hysterectomy and the elevated CVD risk in women.
A nationwide, population-based, retrospective, observational study was conducted in Korea to determine the relationship between hysterectomy and CVD risk among women aged <50 years.1 From January 1, 2007 to December 31, 2020, a total of 135,575 adult Korean women aged 40-49 years were included in this study, of which 49.1% had received hysterectomy.1 The primary endpoint of this observational study was the incidence of CVD, which was defined as the first hospitalization for, or death due to myocardial infarction (MI), coronary artery revascularization (CAR), or stroke.1
With a median follow-up period of 7.9 years, the analysis revealed that the incidence of CVD was 115 per 100 000 person-years for the hysterectomy group and 96 per 100 000 person-years for the non-hysterectomy group.1 Hence, participants in the hysterectomy group were 25% more suspectable to develop CVD compared with the non-hysterectomy group (HR=1.25; 95% CI: 1.09-1.44; p=0.002).1 Both patient groups exhibited similar risks of MI (HR=1.06; 95% CI: 0.56-2.02; p=0.86) and CAR (HR=1.03, 95% CI: 0.74-1.43; p=0.85).1 Notably, patients in the non-hysterectomy group had a significantly elevated risk of stroke when compared with the non-hysterectomy group (HR=1.31; 95% CI: 1.12-1.53; p<0.001).1
In summary, the study results demonstrated that hysterectomy was highly associated with a heightened risk of CVD, particularly stroke, among women younger than 50 years, thus providing a clear connection between hysterectomy and the elevated CVD risk in postmenopausal women.1 However, the incidence of CVD among women who underwent hysterectomy was minuscule. Hence, the existing clinical standards remain adequate and the current clinical practices should not be modified.1
Yuk JS, et al. Association of Early Hysterectomy With Risk of Cardiovascular Disease in Korean Women. JAMA Netw Open. 2023;6(6):e2317145.
Laughlin-Tommaso SK, et al. Cardiovascular and metabolic morbidity after hysterectomy with ovarian conservation: a cohort study. Menopause. 2018;25(5):483-492.
Yeh JS, et al. Hysterectomy in young women associates with higher risk of stroke: a nationwide cohort study. Int J Cardiol. 2013;168(3):2616-2621.
Semaglutide gains FDA approval for treating obesity in adolescents aged ≥12 years
Semaglutide, a glucagon-like peptide-1 (GLP-1) analog that aids in weight loss by suppressing appetite, has recently gained approval from the United States (US) Food and Drug Administration (FDA) to treat obesity in children aged ≥12 years.1,2 The approval was based on the positive findings of a rec
CV outcomes not reduced with routine functional testing after PCI
In the European Society of Cardiology (ESC) Congress 2022, Dr. Duk-Woo Park from the University of Ulsan College of Medicine, Seoul, Korea, presented the results of his group’s investigation into the effectiveness of routine functional testing as a follow-up strategy after percutaneous coronary inte
Comparing the newly FDA-approved tirzepatide with insulin glargine in T2DM patients at high CV risk: The SURPASS-4 trial
Tirzepatide was approved by the U.S. Food and Drug Administration (FDA) on May 13, 2022 as the first and only dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide 1 (GLP-1) receptor agonist for type 2 diabetes mellitus (T2DM), given its potent glucose-lowering effects.1
Preventative statin therapy reduces AHF and mortality in patients with ACS as the first manifestation of ASCVD
Mixed data have been observed on the role of statins in the preventative setting of cardiovascular disease (CVD).1 However, Dr. Raffaele Bugiardini, Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Italy and his colleagues conducted a recent study published in the Journal of the American College of Cardiology, which demonstrated evidence that receiving statin therapy before initial acute coronary syndrome (ACS) could reduce acute heart failure (AHF) and improve patient survival rates.2
Influenza vaccines in HF patients reduce pneumonia and hospitalizationsa
In the American College of Cardiology (ACC) 2022 Scientific Session, Professor Mark Loeb from McMaster University, Canada, discussed his randomized controlled trial of influenza vaccines in heart failure (HF) patients to reduce adverse vascular events.1 The risk of cardiovascular (CV) events and de
Guidelines for the evaluation and diagnosis of chest pain
Chest pain is one of the most common reasons for patients to present to the emergency department, and the acute coronary syndrome (ACS) needs to be distinguished from a variety of other cardiac and non-cardiac diseases that may cause chest pain.1 Which is the dominant and most frequent symptom for both men and women ultimately diagnosed with ACS. Women may be more likely to present with accompanying symptoms such as nausea and shortness of breath. The first-ever clinical guideline from the American College of Cardiology (ACC) and American Heart Association (AHA) for the evaluation and diagnosis of patients with chest pain who are sent to the emergency department, provides recommendations and algorithms to conduct initial assessment of chest pain for triaging patients effectively on the basis of the likelihood that the symptoms may be attributable to myocardial infarction (MI).1
Latest guideline addresses the gap in managing adult stage 1 hypertension with a low 10-year ASCVD risk
The 2017 Hypertension Clinical Practice Guideline issued by the American College of Cardiology/American Heart Association (ACC/AHA) Task Force outlined the general blood pressure (BP) management approach to adults with stage 1 hypertension and a 10-year risk for atherosclerotic cardiovascular diseas
IG-IMRT as a more favorable adjuvant radiation alternative for hysterectomized cervical cancer patients
Radiotherapy as adjuvant treatment after total hysterectomy has proven to be effective in lowering cancer-specific mortality rate.1 However, traditional three-dimensional conformal radiotherapy (3D-CRT) as adjuvant treatment after total hysterectomy is associated with a series of late gastrointestin