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de Lange ME, Semmler A, Clark TJ, Mol BWJ, Bet PM, Huirne JAF, Hehenkamp WJK. Considerations on implementation of the newest treatment for symptomatic uterine fibroids: Oral GnRH antagonists. Br J Clin Pharmacol 2024; 90:392-405. [PMID: 37653680 DOI: 10.1111/bcp.15897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/02/2023] Open
Abstract
Novel gonadotrophin releasing hormone (GnRH) antagonist treatments have recently been developed in combination with hormonal add-back therapy, as an oral treatment option for women suffering from uterine fibroids. Registration trials assessing the GnRH antagonist combination preparations with relugolix, elagolix and linzagolix have assessed treatment efficacy for fibroid-related heavy menstrual blood loss in comparison to placebo. Marketing authorization has been granted by several agencies including those in Europe, the United Kingdom and the United States. While the registration trials report a robust effect on the reduction of heavy menstrual blood loss and improvement in quality of life scores, reticence is advised before widespread prescription. In this review, we demonstrate limitations in the trial data, namely a lack of generalizability due to the restricted study population, the lack of transparency in the distribution of disease-level characteristics limiting the predictability of treatment success in the real-world diverse population, and the absence of any comparison to current alternative treatment methods. Importantly, no clinically meaningful volume reductions were found with GnRH antagonist combination preparations, and long-term safety data, particularly concerning modest but stable bone mineral density decline, need further addressing. Symptoms related to uterine fibroids adversely affect many women's quality of life and effective medical treatments are lacking. However, despite the urgent need for conservative treatments, it is vitally important that novel drugs, like combination oral GnRH antagonists, undergo sufficiently rigorous evaluation of safety, effectiveness and cost-effectiveness in a representative population and are compared with alternative treatment methods before introduction into mainstream clinical practice.
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Affiliation(s)
- Maria E de Lange
- Department of Obstetrics and Gynaecology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Annika Semmler
- Department of Obstetrics and Gynaecology, Amsterdam UMC, location Vrije Universteit MC, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - T Justin Clark
- Department of Obstetrics and Gynaecology, Birmingham Women's and Children's Hospital, Birmingham, UK
| | - Ben Willem J Mol
- Department of Obstetrics and Gynaecology, Monash University Monash Medical Centre, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology, Aberdeen Centre for Women's Health Research, University of Aberdeen, Aberdeen, UK
- Department of Obstetrics and Gynaecology, University of Aberdeen, Aberdeen, UK
| | - Pierre M Bet
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Judith A F Huirne
- Department of Obstetrics and Gynaecology, Amsterdam UMC, location Vrije Universteit MC, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Wouter J K Hehenkamp
- Department of Obstetrics and Gynaecology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam UMC, location Vrije Universteit MC, Amsterdam, The Netherlands
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de Lange ME, Huirne JAF. Linzagolix: an oral gonadotropin-releasing hormone receptor antagonist treatment for uterine fibroid-associated heavy menstrual bleeding. Lancet 2022; 400:866-867. [PMID: 36116467 DOI: 10.1016/s0140-6736(22)01781-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 09/06/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Maria E de Lange
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
| | - Judith A F Huirne
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam Medical Centers, Amsterdam 1105 AZ, Netherlands.
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Keizer AL, Jacobs BL, Thurkow AL, de Lange ME, Radder CM, van Kesteren PJM, Hanstede MMF, Huirne JAF, Hehenkamp WJK. The effect of transcervical resection of submucous fibroids on menstrual blood loss: A prospective cohort study. Eur J Obstet Gynecol Reprod Biol 2022; 274:128-135. [PMID: 35640441 DOI: 10.1016/j.ejogrb.2022.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/16/2022] [Accepted: 05/19/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Transcervical resection of myoma (TCRM) is a widely implemented treatment for submucous fibroids. The aim of this study is to evaluate the effect of TCRM on menstrual bleeding, fibroid related symptoms and quality of life and hemoglobin (Hb) levels. STUDY DESIGN A prospective cohort study was conducted in three teaching hospitals and two academic hospitals in the Netherlands. Patients with HMB (PBAC score > 150) and submucous fibroids (type 0, 1, 2, 3, 4 and hybrid type 2-5) scheduled for TCRM were eligible. At baseline and 3 months after TCRM a Trans Vaginal Ultrasound (TVU) was performed and a Hb sample was taken. Patients filled out the Pictorial Blood Assessment Chart (PBAC) and the Uterine Fibroid Symptom and Quality of Life (UFS-QOL) questionnaire at baseline and up to 6 months after surgery. Primary outcome was improvement in PBAC score 6 months after surgery. Secondary outcomes were improvement in PBAC score and Hb level 3 months after surgery and UFS-QOL scores 3 and 6 months after surgery. RESULTS 126 patients were included and 104 were operated. PBAC were obtained from 98 patients. Six months after surgery, 56.6% of patients went from HMB to normal menstrual bleeding (PBAC < 150). A significant reduction in median PBAC scores of 427 (IQR 198 - 1392) (p <.0001) was found (86% improvement). UFS-QOL scores were obtained from 91 patients. Symptom severity improved from a median of 54 on a scale of 100 (IQR 44-66) at baseline to 22 (IQR 9-41) after 6 months (p <.0001) (59% improvement). Health related quality of life (HRQOL) improved from a median score of 44 on a scale of 100 (IQR 33-62) to 89 (IQR 67-97) 6 months after surgery (p <.0001) (102% improvement). CONCLUSION TCRM significantly reduces the amount of menstrual bleeding, severity of fibroid related symptoms and improves HRQOL in patients with submucous fibroids.
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Affiliation(s)
- Alieke L Keizer
- Amsterdam UMC, Location VUmc, Department of Obstetrics and Gynecology, De Boelelaan 1117 1081 HV Amsterdam, The Netherlands.
| | - Bracha L Jacobs
- Amsterdam UMC, Location VUmc, Department of Obstetrics and Gynecology, De Boelelaan 1117 1081 HV Amsterdam, The Netherlands
| | - Andreas L Thurkow
- Bergman Clinics Amsterdam, Nijenburg 152, 1081 GG Amsterdam & Amsterdam UMC, Location AMC, Department of Obstetrics and Gynecology, Meibergdreef 9 1105, The Netherlands
| | - Maria E de Lange
- Amsterdam UMC, Location AMC, Department of Obstetrics and Gynecology, Meibergdreef 9 1105 AZ Amsterdam, The Netherlands
| | - Celine M Radder
- OLVG Location West, Department of Obstetrics and Gynecology, Jan Tooropstraat 164 1061 AE Amsterdam, The Netherlands
| | - Paul J M van Kesteren
- OLVG Location East, Department of Obstetrics and Gynecology, Oosterpark 9 1091 AC Amsterdam, The Netherlands
| | - Miriam M F Hanstede
- Spaarne Gasthuis, Location Hoofddorp, Department of Obstetrics and Gynecology, Spaarnepoort 1, 2134 TM Hoofddorp, The Netherlands
| | - Judith A F Huirne
- Amsterdam UMC, Location VUmc, Department of Obstetrics and Gynecology, De Boelelaan 1117 1081 HV Amsterdam, The Netherlands
| | - Wouter J K Hehenkamp
- Amsterdam UMC, Location VUmc, Department of Obstetrics and Gynecology, De Boelelaan 1117 1081 HV Amsterdam, The Netherlands
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Abstract
Ulipristal acetate (UPA) is a medical treatment for uterine fibroids and was authorized for surgical pre-treatment in 2012 after the conduct of the PEARL I and II randomized controlled trials and for intermittent treatment after the observational PEARL III and IV trials. However, UPA came into disrepute due to its temporary suspension in 2017 and 2020 because of an apparent association with liver injury. This clinical opinion paper aims to review the process of marketing authorization and implementation of UPA, in order to provide all involved stakeholders with recommendations for the introduction of future drugs. Before marketing authorization, the European Medicines Agency (EMA) states that Phase III registration trials should evaluate relevant outcomes in a representative population, while comparing to gold-standard treatment. This review shows that the representativeness of the study populations in all PEARL trials was limited, surgical outcomes were not evaluated and intermittent treatment was assessed without comparative groups. Implementation into clinical practice was extensive, with 900 000 prescribed treatment cycles in 5 years in Europe and Canada combined. Extremely high costs are involved in developing and evaluating pre-marketing studies in new drugs, influencing trial design and relevance of chosen outcomes, thereby impeding clinical applicability. It is vitally important that the marketing implementation after authorization is regulated in such way that necessary evidence is generated before widespread prescription of a new drug. All stakeholders, from pharmaceutical companies to authorizing bodies, governmental funding bodies and medical professionals should be aware of their role and take responsibility for their part in this process.
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Affiliation(s)
- Mei-An Middelkoop
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Correspondence address. Amsterdam UMC, Location de Boelelaan, Postbus 7057, 1007 MB Amsterdam, The Netherlands. Tel: +31-20-444-4444; E-mail: https://orcid.org/0000-0003-0847-2566
| | - Maria E de Lange
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - T Justin Clark
- Department of Obstetrics and Gynaecology, Birmingham Women’s and Children’s Hospital, Birmingham, UK
| | - Ben Willem J Mol
- Department of Obstetrics and Gynaecology, Monash University Monash Medical Centre, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology, Aberdeen Centre for Women's Health Research, University of Aberdeen, Aberdeen, UK
- Department of Obstetrics and Gynaecology, University of Aberdeen Aberdeen, Aberdeen, UK
| | - Pierre M Bet
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Judith A F Huirne
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Wouter J K Hehenkamp
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Keizer AL, van Kesteren PJM, Terwee C, de Lange ME, Hehenkamp WJK, Kok HS. Uterine Fibroid Symptom and Quality of Life questionnaire (UFS-QOL NL) in the Dutch population: a validation study. BMJ Open 2021; 11:e052664. [PMID: 34815284 PMCID: PMC8611425 DOI: 10.1136/bmjopen-2021-052664] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Uterine fibroids can cause a variety of symptoms in women, from heavy menstrual bleeding and dysmenorrhea to bulk symptoms. The Uterine Fibroid Symptom and health-related Quality Of Life questionnaire (UFS-QOL) is a patient-reported outcome measure developed for assessing fibroid-related symptoms in a standardised way. Our aim was to translate and validate the UFS-QOL in Dutch. DESIGN Validation study. SETTING Patients were recruited by a gynaecologist at the outpatient clinic. PARTICIPANTS Women with uterine fibroids. METHODS The UFS-QOL was translated into Dutch (UFS-QOL NL) and validated through testing construct validity (comprising of structural validity and hypotheses testing), reliability, responsiveness and interpretability, assessing floor and ceiling effects and minimal important change. An option to answer 'not applicable' was added to the translated questionnaire. RESULTS 191 women with uterine fibroids completed the UFS-QOL NL at baseline, after 2 weeks and after 3 months. The questionnaire retained the same factor structure after translation (Comparative Fit Index 0.94-0.95; Tucker-Lewis fit Index 0.93-0.95; Root Mean Square Error of Approximation 0.10-0.11) and correlations to other questionnaires (RAND 36, Hospital Anxiety and Depression Scale and Golombok Rust Inventory of Sexual Satisfaction) were generally moderate, as hypothesised (Pearson's r 0.3-0.7). We found a sufficient reliability with intraclass correlation coefficients of approximately 0.8-0.9 for all subscales. Responsiveness was sufficient when testing hypotheses comparing women who had surgery with those who did not. Cronbach's alpha was higher than 0.7 for all subscales, indicating sufficient internal consistency and there were no concerns about floor or ceiling effects. Minimal important change could not be calculated due to low correlation between the different subscales and the anchor question. CONCLUSIONS The results support the measurement properties of the Dutch UFS-QOL for assessing fibroid-related symptoms and health-related quality of life in Dutch women with uterine fibroids.
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Affiliation(s)
- Alieke L Keizer
- Obstetrics and Gynaecology, Amsterdam UMC, Amsterdam, The Netherlands
| | | | - Caroline Terwee
- Epidemiology and Data Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Maria E de Lange
- Obstetrics and Gynaecology, Amsterdam UMC, Amsterdam, The Netherlands
| | | | - Helen S Kok
- Obstetrics and Gynaecology, Alrijne Ziekenhuis Locatie Leiden, Leiden, The Netherlands
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Hamulyák EN, Wiegers HMG, Scheres LJJ, Hutten BA, de Lange ME, Timmermans A, Westerweel PE, Nijziel MR, Kruip MJHA, ten Wolde M, Ypma PF, Klok FA, Nieuwenhuizen L, van Wissen S, Hovens MMC, Faber LM, Kamphuisen PW, Büller HR, Middeldorp S. Heavy menstrual bleeding on direct factor Xa inhibitors: Rationale and design of the MEDEA study. Res Pract Thromb Haemost 2021; 5:223-230. [PMID: 33537547 PMCID: PMC7845056 DOI: 10.1002/rth2.12471] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 10/19/2020] [Accepted: 11/16/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND In premenopausal women, treatment with direct oral factor Xa inhibitors is associated with an increased risk of heavy menstrual bleeding (HMB) compared with vitamin K antagonists (VKA). Treatment with the direct oral thrombin inhibitor dabigatran appears to be associated with a reduced risk of HMB compared with VKA. These findings come from small observational studies or post hoc analyses of trials in which HMB was not a primary outcome. Use of tranexamic acid during the menstrual period may be effective in patients with HMB, but prospective data regarding efficacy and safety in patients on anticoagulant treatment are lacking. RATIONALE AND DESIGN A direct comparison of a factor Xa inhibitor and a thrombin inhibitor with HMB as primary outcome, as well as an evaluation of the effects of adding tranexamic acid in women with anticoagulant-associated HMB is highly relevant for clinical practice. The MEDEA study is a randomized, open-label, pragmatic clinical trial to evaluate management strategies in premenopausal women with HMB associated with factor Xa inhibitor therapy. OUTCOMES Women using factor Xa inhibitors with proven HMB, as assessed by a pictorial blood loss assessment chart (PBAC) score of >150, will be randomized to one of three study arms: (i) switch to dabigatran; (ii) continue factor Xa inhibitor with addition of tranexamic acid during the menstrual period; or (iii) continue factor Xa inhibitor without intervention. The primary outcome is the difference in PBAC score before and after randomization. Here, we present the rationale and highlight several unique features in the design of the study.
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Affiliation(s)
- Eva N. Hamulyák
- Department of Vascular MedicineAmsterdam UMCAmsterdam Cardiovascular SciencesUniversity of AmsterdamAmsterdamThe Netherlands
| | - Hanke M. G. Wiegers
- Department of Vascular MedicineAmsterdam UMCAmsterdam Cardiovascular SciencesUniversity of AmsterdamAmsterdamThe Netherlands
| | - Luuk J. J. Scheres
- Department of Vascular MedicineAmsterdam UMCAmsterdam Cardiovascular SciencesUniversity of AmsterdamAmsterdamThe Netherlands
- Department of Internal MedicineRadboud University Medical CenterNijmegenThe Netherlands
| | - Barbara A. Hutten
- Department of Clinical Epidemiology, Biostatistics and BioinformaticsAmsterdam UMCAmsterdam Cardiovascular SciencesUniversity of AmsterdamAmsterdamThe Netherlands
| | - Maria E. de Lange
- Department of Gynecology and ObstetricsAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Anne Timmermans
- Department of Gynecology and ObstetricsAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Peter E. Westerweel
- Department of Internal MedicineAlbert Schweitzer HospitalDordrechtThe Netherlands
| | - Marten R. Nijziel
- Department of HematologyCatharina Hospital EindhovenEindhovenThe Netherlands
| | | | - Marije ten Wolde
- Department of Internal MedicineFlevo HospitalAlmereThe Netherlands
| | - Paula F. Ypma
- Department of HematologyHaga HospitalThe HagueThe Netherlands
| | - Frederikus A. Klok
- Department of Thrombosis and HaemostasisLeiden University Medical CentreLeidenThe Netherlands
| | | | | | | | - Laura M. Faber
- Department of Internal MedicineRed Cross HospitalBeverwijkThe Netherlands
| | - Pieter W. Kamphuisen
- Department of Vascular MedicineAmsterdam UMCAmsterdam Cardiovascular SciencesUniversity of AmsterdamAmsterdamThe Netherlands
- Department of Internal MedicineTergooi HospitalHilversumThe Netherlands
| | - Harry R. Büller
- Department of Vascular MedicineAmsterdam UMCAmsterdam Cardiovascular SciencesUniversity of AmsterdamAmsterdamThe Netherlands
| | - Saskia Middeldorp
- Department of Vascular MedicineAmsterdam UMCAmsterdam Cardiovascular SciencesUniversity of AmsterdamAmsterdamThe Netherlands
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van Dijk MM, van Hanegem N, de Lange ME, Timmermans A. Treatment of Women With an Endometrial Polyp and Heavy Menstrual Bleeding: A Levonorgestrel-Releasing Intrauterine Device or Hysteroscopic Polypectomy? J Minim Invasive Gynecol 2015; 22:1153-62. [PMID: 26151760 DOI: 10.1016/j.jmig.2015.06.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 06/12/2015] [Accepted: 06/17/2015] [Indexed: 11/25/2022]
Abstract
We performed a literature review of reports comparing a levonorgestrel-releasing intrauterine device (LNG-IUD) with transcervical polyp resection (TCRP) as a treatment for heavy menstrual bleeding (HMB). Our second objective was to investigate the effectiveness of LNG-IUD and TCRP in reducing menstrual bleeding and the patient satisfaction with each technique. No previously reported studies have compared TCRP and LNG-IUD as treatment for HMB in premenopausal women with an endometrial polyp. Likewise, no studies are available on LNG-IUD as a treatment for HMB in the presence of an endometrial polyp. Several studies have found the LNG-IUD to be an effective treatment option for HMB, with high patient satisfaction rates. Evidence of the effectiveness of TCRP as treatment of HMB is scarce. Patient satisfaction is reported relatively good, although persistent or recurrent symptoms appear to be frequent. We conclude that no evidence is available on LNG-IUD as treatment for HMB in women with an endometrial polyp. We hypothesize that LNG-IUD could be a good alternative to TCRP for treating HMB in premenopausal women with a polyp; however, further evidence is needed, and a randomized controlled trial should be performed.
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Affiliation(s)
- Myrthe M van Dijk
- Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
| | - Nehalennia van Hanegem
- Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands; Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, University of Maastricht, Maastricht, The Netherlands
| | - Maria E de Lange
- Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Anne Timmermans
- Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Haan YC, Oudman I, de Lange ME, Timmermans A, Ankum WM, van Montfrans GA, Brewster LM. Hypertension risk in Dutch women with symptomatic uterine fibroids. Am J Hypertens 2015; 28:487-92. [PMID: 25241046 DOI: 10.1093/ajh/hpu183] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Female-specific risk factors for cardiovascular disease are understudied. We assessed whether women with uterine fibroids have a greater hypertension risk, independent of the shared risk factors for both conditions. METHODS Blood pressure was measured in women scheduled for fibroid surgery compared to women scheduled for nonfibroid gynecological surgery and women randomly sampled from the general population. We used multivariable binary logistic regression to assess whether hypertension was more common with surgically treated fibroids, independent of age, body mass index, and African ancestry. RESULTS We included 1,342 women (542 of African ancestry), of which 272 scheduled for fibroid surgery, 385 controls scheduled for nonfibroid gynecological surgery, and 685 random population controls, with a mean age (SD) of, respectively, 43.4 (6.6), 41.3 (10.2), and 45.1 (6.6) years; and a mean body mass index (SD) of, respectively, 27.4 (5.3), 25.7 (5.7), and 28.2 (5.6) kg/m(2). Hypertension was found more frequently with surgically treated fibroids, with an occurrence of 41.9% in women with fibroids vs. 27.5% in surgical controls, and 28.3% in population controls (P < 0.001 for fibroids vs. controls). The association with hypertension was independent of age, body mass index, and African ancestry (odds ratio, 2.4; 95% confidence interval, 1.7-3.4). CONCLUSIONS Hypertension risk is higher in Dutch women with surgically treated fibroids than in surgery or population controls, independent of age, body mass index, and African ancestry. Our data add to the body of evidence indicating that women with uterine fibroids are eligible for hypertension screening.
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Affiliation(s)
- Yentl C Haan
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands;
| | - Inge Oudman
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Maria E de Lange
- Department of Gynaecology and Obstetrics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Anne Timmermans
- Department of Gynaecology and Obstetrics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Willem M Ankum
- Department of Gynaecology and Obstetrics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Gert A van Montfrans
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Lizzy M Brewster
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Social Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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