Associations between Hysterectomy and Metabolic Syndrome: The Multi-Ethnic Study of Atherosclerosis

BACKGROUND

Metabolic syndrome is linked to an increased risk of incident cardiovascular disease (CVD) and all-cause mortality. Notable associations exist between hysterectomy with bilateral salpingo-oophorectomy and metabolic syndrome. However, there is emerging evidence that even with ovarian conservation, hysterectomy may be independently associated with long-term CVD risk.

OBJECTIVE

To examine the associations between hysterectomy with ovarian preservation and metabolic syndrome risk in a multi-ethnic cohort.

METHODS

We studied 3,367 female participants in the Multi-Ethnic Study of Atherosclerosis who had data on self-reported history of hysterectomy, oophorectomy, hystero-oophorectomy and metabolic syndrome at baseline (2000-2002). We used adjusted logistic regression to assess the cross-sectional associations between hysterectomy/oophorectomy subgroups and prevalent metabolic syndrome at baseline. Furthermore, we investigated 1,355 participants free of baseline metabolic syndrome and used adjusted Cox regression models to evaluate incident metabolic syndrome from exams 2 (2002-2004) to 6 (2016-2018).

RESULTS

The mean±SD age was 59.0±9.5 years, with 42% White, 27% Black, 19% Hispanic, and 13% Chinese American participants. 29% and 22% had a history of hysterectomy and oophorectomy, respectively. Over a median follow-up period of 10.5 (3.01-17.62) years, there were 750 metabolic syndrome events. Hysterectomy [HR, 1.32 (95%CI, 1.01-1.73)] and hystero-oophorectomy [1.40 (1.13-1.74)] were both strongly associated with incident metabolic syndrome compared to having neither hysterectomy or oophorectomy.

CONCLUSION

Hysterectomy, even with ovarian preservation, may be independently associated with a higher risk of metabolic syndrome. If other studies confirm these findings, screening and preventive strategies focused on females with ovary-sparing hysterectomy and the mechanisms underpinning these associations may be explored.

Ideal Cardiovascular Health and Adipokine Levels: The Multi-Ethnic Study of Atherosclerosis (MESA)

OBJECTIVE

Adipokines are hormones implicated in obesity and its cardiometabolic consequences. The concept of ideal cardiovascular health (CVH) was introduced to promote 7 key health factors and behaviors in the general population. Prior studies have found strong associations between obesity and ideal CVH. We now sought to evaluate the association between CVH and adipokines.

METHODS

We studied 1,842 MESA participants free of cardiovascular disease (CVD), who had 7 CVH metrics (smoking, body mass index, physical activity, diet, total cholesterol, blood pressure and fasting blood glucose) measured at baseline and serum adipokine levels measured at a median of 2.4 years later. Each CVH metric was assigned a score of 0(poor), 1(intermediate) and 2(ideal), and summed for a total CVH score (0-14). Total CVH scores of 0-8 were considered inadequate, 9-10 average, and 11-14 optimal. We used multivariable linear regression models to assess the non-concurrent associations between CVH score and log-transformed adipokine levels.

RESULTS

The mean age was 62.1±9.8 years; 50.2% of participants were men. After adjusting for sociodemographic factors, a 1-unit higher CVH score was significantly associated with 4% higher adiponectin and 15% and 1% lower leptin and resistin levels. Individuals with optimal CVH scores had 27% higher adiponectin and 56% lower leptin levels compared to those with inadequate CVH scores. Similar trends were observed for those with average versus inadequate CVH scores.

CONCLUSION

In a multi-ethnic cohort free of CVD at baseline, individuals with average and optimal CVH scores had a more favorable adipokine profile than those with inadequate CVH.

Abstract P517: Ideal Cardiovascular Health and Adipokine Levels: The Multi-Ethnic Study of Atherosclerosis (MESA)

Introduction: Adipokines are hormones implicated in obesity and its cardiometabolic consequences. The concept of ideal cardiovascular health (CVH) was introduced to monitor and promote 7 (now 8) key health factors and behaviors in the general population. Although prior studies have found strong associations between obesity and ideal CVH, the link between CVH and adipokines has not been elucidated. We examined the associations between CVH and adipokine levels in MESA.

Methods: We studied 1,842 MESA participants who were free of cardiovascular disease at baseline, had 7 CVH metrics (smoking, body mass index, physical activity, diet, total cholesterol, blood pressure and fasting blood glucose) measured at exam 1 (2000-2002) and adipokine levels measured at either exam 2 or 3 (2002-2004 or 2004-2005). Each metric was assigned a score of 0(poor), 1(intermediate) and 2(ideal), and summed to obtain a total CVH score (0 -14). We used multivariable linear regression models to assess the non-concurrent cross-sectional associations between CVH score and log-transformed serum adipokine levels, adjusting for sociodemographic factors.

Results: The mean ± SD age was 62.1 ± 9.8 years and 50.2% of participants were men. Median (IQR) adiponectin, leptin and resistin levels were 17.4 (11.8 - 26.3) mcg/mL,13.3 (5.6 - 28.2) ng/mL and 15.0 (11.9 - 19.0) ng/mL, respectively. A 1 unit higher CVH score was significantly associated with 4% higher adiponectin, 15% and 1% lower leptin and resistin levels respectively, after adjusting for sociodemographic factors. Individuals with optimal CVH scores had 27% higher adiponectin and 56% lower leptin levels compared to those with inadequate CVH scores. Similar results were obtained for those with average scores (Table).

Conclusion: In a multi-ethnic cohort free of cardiovascular disease at baseline, individuals with average and optimal CVH scores had higher adiponectin and lower leptin and resistin levels compared to those with inadequate CVH scores.

Adipokines and incident venous thromboembolism: The Multi-Ethnic Study of Atherosclerosis

BACKGROUND

Obesity leads to adipocyte hypertrophy and adipokine dysregulation and is an independent risk factor for venous thromboembolism (VTE). However, the association between adipokines and VTE is not well established.

OBJECTIVES

To examine whether adipokines are associated with increased risk of incident VTE.

METHODS

We studied 1888 participants of the Multi-Ethnic Study of Atherosclerosis cohort who were initially free of VTE and had adipokine (adiponectin, leptin, and resistin) levels measured at either examination 2 or 3 (2002-2004 or 2004-2005, respectively). During follow-ups, VTE was ascertained through hospitalization records and death certificates by using ICD-9 and 10 codes. We used multivariable Cox proportional hazards regression to assess the association between 1 standard deviation (SD) log-transformed increments in adipokines and incident VTE.

RESULTS

The mean ± SD age was 64.7 ± 9.6 years, and 49.8% of participants were women. Medians (interquartile range) of adiponectin, leptin, and resistin were 17.3 (11.8-26.2) mcg/mL, 13.5 (5.6-28.2) ng/mL, and 15.0 (11.9-19.0) ng/mL, respectively. There were 78 incident cases of VTE after a median of 9.7 (5.0-12.4) years of follow-up. After adjusting for sociodemographics, smoking, and physical activity, the hazard ratios (95% CIs) per 1 SD increment of adiponectin, leptin, and resistin were 1.14 (0.90-1.44), 1.29 (1.00-1.66), and 1.38 (1.09-1.74), respectively. The association for resistin persisted after further adjustments for body mass index and computed tomography-derived total visceral adipose tissue area.

CONCLUSION

Higher resistin levels were independently associated with greater risk of incident VTE. Larger prospective cohort studies are warranted to confirm this association.

Migration-Related Weight Changes among African Immigrants in the United States

(1) Background: people who migrate from low-to high-income countries are at an increased risk of weight gain, and excess weight is a risk factor for cardiovascular disease. Few studies have quantified the changes in body mass index (BMI) pre- and post-migration among African immigrants. We assessed changes in BMI pre- and post-migration from Africa to the United States (US) and its associated risk factors. (2) Methods: we performed a cross-sectional analysis of the African Immigrant Health Study, which included African immigrants in the Baltimore-Washington District of the Columbia metropolitan area. BMI category change was the outcome of interest, categorized as healthy BMI change or maintenance, unhealthy BMI maintenance, and unhealthy BMI change. We explored the following potential factors of BMI change: sex, age at migration, percentage of life in the US, perceived stress, and reasons for migration. We performed multinomial logistic regression adjusting for employment, education, income, and marital status. (3) Results: we included 300 participants with a mean (±SD) current age of 47 (±11.4) years, and 56% were female. Overall, 14% of the participants had a healthy BMI change or maintenance, 22% had an unhealthy BMI maintenance, and 64% had an unhealthy BMI change. Each year of age at immigration was associated with a 7% higher relative risk of maintaining an unhealthy BMI (relative risk ratio [RRR]: 1.07; 95% CI 1.01, 1.14), and compared to men, females had two times the relative risk of unhealthy BMI maintenance (RRR: 2.67; 95% CI 1.02, 7.02). Spending 25% or more of life in the US was associated with a 3-fold higher risk of unhealthy BMI change (RRR: 2.78; 95% CI 1.1, 6.97). (4) Conclusions: the age at immigration, the reason for migration, and length of residence in the US could inform health promotion interventions that are targeted at preventing unhealthy weight gain among African immigrants.

The Diabetes-Cardiovascular Connection in Women: Understanding the Known Risks, Outcomes, and Implications for Care

PURPOSE OF REVIEW

Cardiovascular disease (CVD) complications constitute about 50-70% of mortality in people with diabetes. However, there remains a persistently greater relative increase in CVD morbidity and mortality in women with diabetes than in their male counterparts. This review presents recent evidence for the risks, outcomes, and management implications for women with diabetes.

RECENT FINDINGS

Compared to men, women have higher BMI and more adverse cardiovascular risk profile at time of diabetes diagnosis with greater risk for coronary heart disease, stroke, vascular dementia, and heart failure. Pregnancy-specific risk factors of gestational diabetes and pre-eclampsia are associated with future type 2 diabetes (T2D) and CVD. Women with T2D may experience greater benefits than men from GLP-1 receptor agonists. Women with diabetes are at greater relative risk for CVD complications than men, with poorer outcomes, superimposed on preexisting gender disparities in social determinants of health, lower likelihood of being offered cardioprotective interventions, and enrollment in trials. Further research and the utilization of SGLT-2 inhibitors, GLP-1 receptor agonists, and other CVD prevention strategies will help reduce morbidity and mortality.