The effect of hysterectomy or levonorgestrel-releasing intrauterine system on cardiovascular disease risk factors in menorrhagia patients: a 10-year follow-up of a randomised trial

S Heliövaara-Peippo, Satu Heliövaara‐Peippo, R. Oksjoki, K. Halmesmäki, Karoliina Halmesmäki, Risto Kaaja, R Kaaja, J. Teperi, Juha Teperi, Seija Grénman, S Grenman, A Kivelä, Aarre Kivelä, H-M Surcel, Heljä‐Marja Surcel, Eija Tomás, E Tomas, M. Tuppurainen, R. Hurskainen, Ritva Hurskainen, J Paavonen, Jorma Paavonen
Maturitas · 2011 · vol. 69(4) , pp. 354–358 · doi:10.1016/j.maturitas.2011.05.004 · PMID:21684096 · W2036176489
RCT OA: closed CC0 ⤵ 1 in-corpus citation
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This randomized trial followed menorrhagia patients for 10 years to compare cardiovascular disease risk factors after hysterectomy versus a levonorgestrel-releasing intrauterine system.

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Abstract

OBJECTIVE: To compare, whether women with menorrhagia, treated with either hysterectomy or LNG-IUS, differ in their cardiovascular risk profile during 10-year follow-up. STUDY DESIGN: A total of 236 women were randomized to treatment by hysterectomy (n=117) or LNG-IUS (n=119). Their cardiovascular risk factors were analyzed at baseline, at 5 years, and at 10 years. As 55 originally randomized to the LNG-IUS group had hysterectomy during the follow-up, all analyzes were performed by actual treatment modality. MAIN OUTCOME MEASURES: Waist circumference, body-mass index (BMI), blood pressure, and the levels of blood lipids, serum high-sensitivity CRP (hsCRP) and tumor necrosis factor alpha (TNF-α) were measured, and the use of medication for hypertension, diabetes, hypercholesterolemia, and ischemic heart disease was analyzed. RESULTS: After 5 years, an increase in the use of diabetes medication during the follow-up was only detected in the hysterectomy group (from 1.7% to 6.7%, P=0.008 vs from 5.1% to 8.4%, P=0.08), as well as they had significantly higher serum levels of TNF-α (108.59 pg/ml vs 49.02 pg/ml, P=0.001) and hsCRP (1.55 μg/ml vs 0.78 μg/ml, P=0.038) at 5- and 10-years. There was no difference between the groups in the use of cardiovascular medication, neither was there difference in blood pressure, waist circumference, BMI, or concentrations of blood lipids. CONCLUSIONS: Hysterectomy seems to be associated with increased levels of serum inflammatory markers and increased diabetes medication, which in turn, may predispose individual to future cardiovascular events.

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MeSH descriptors

Cardiovascular Diseases Diabetes Mellitus Hysterectomy Inflammation Levonorgestrel Menorrhagia Progestins Adult Cardiovascular Diseases Cardiovascular Diseases C-Reactive Protein C-Reactive Protein Diabetes Mellitus Diabetes Mellitus Diabetes Mellitus Female Follow-Up Studies Humans Hypoglycemic Agents Hypoglycemic Agents

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