Cardiovascular risk factors at 24 months after risk-reducing salpingo-oophorectomy: a prospective controlled study from WHAM.

BACKGROUND

Women at risk of ovarian cancer due to BRCA1/2 pathogenic variants are advised to undergo bilateral risk-reducing salpingo-oophorectomy (RRSO) prior to natural menopause. Epidemiologic evidence suggests that surgical menopause increases cardiovascular disease risk, but prospective data are limited. It is also unknown how timing of RRSO impacts cardiovascular risk and whether this risk is mitigated by menopausal hormone therapy (MHT). We aimed to prospectively measure cardiometabolic risk factors 24 months after premenopausal RRSO compared to age-matched women who retained their ovaries.

METHODS

Prospective observational study from baseline to 24 months in 104 RRSO women and 102 controls who retained their ovaries. At baseline and 24 months, blood pressure, body mass index (BMI), waist and hip circumference, fasting lipids, high-sensitivity C-reactive protein (hs-CRP), glucose, and insulin were measured, and homeostatic model assessment of insulin resistance was calculated. Analyses were performed using generalized estimating equations, adjusting for baseline age, smoking status, vasomotor symptoms, and height (for BMI).

FINDINGS: Baseline cardiometabolic phenotypes were similar between groups. At 24 months, there was no difference between groups in the rise in diastolic blood pressure of ≥5 mm Hg (adjusted odds ratio, 1.03; 95% confidence interval, 0.48 to 2.18). There was no evidence of a difference between groups in changes in BMI, waist circumference, high-density lipoprotein cholesterol (HDL-C), non-HDL-C, low-density lipoprotein cholesterol, triglycerides, hs-CRP, or markers of glucose metabolism at 24 months. After RRSO, 62% of women used MHT, but there was no difference in any measured cardiometabolic marker between MHT users and nonusers.

INTERPRETATION: Surgical menopause did not clearly impact cardiometabolic status at 24 months. Cardiometabolic risk markers did not appreciably differ between MHT users and nonusers.