移除卵巢不能降低糖尿病女性的CVD風險


  【24drs.com】一篇新研究認為,停經後的第二型糖尿病女性患者中,有雙側輸卵管卵巢切除術病史者,死於心血管疾病(CVD)的機率並未降低,不過,在45歲以下婦女,卵巢切除術和CVD有關聯。
  
  這些研究結果由明尼亞波利斯明尼蘇達大學的Duke Appiah博士等人,線上發表於10月12日糖尿病照護期刊。
  
  作者們表示,這些資料來自參與骨質疏鬆性骨折之大型研究的其中7,977名女性,認為相較於沒有糖尿病的婦女或不論有無糖尿病的同齡男性,高雄性素血症(hyperandrogenemia)不是第二型糖尿病婦女更可能發生心衰竭與死於心血管事件的主要解釋因素。
  
  Appiah博士表示,至於年輕女性在卵巢切除術和心血管疾病之間的關聯,並不會削弱前述解釋。
  
  我們以前的研究和其他人的研究都顯示,雙側輸卵管卵巢切除術與心血管疾病之間的整體關聯,似乎是因為在比較年輕時進行卵巢切除術而引起。
  
  因此,Appiah博士指出,卵巢切除術並不一定意謂著比較容易發生心血管疾病,我們的分析認為,卵巢切除和心血管疾病之間的正相關,反而反映出在較年輕時即進行卵巢切除術婦女的不良心血管健康。
  
  他表示,研究結果有幾個臨床意義。
  
  第一,他們並未支持雙側輸卵管卵巢切除術對於心血管健康有直接負面影響的看法。第二,雙側輸卵管卵巢切除術對於糖尿病婦女缺乏好處,意謂著治療他們的高雄性素血症不太能改善他們的心血管健康。
  
  他指出,他們的研究結果並未挑戰目前的觀念,年輕時進行雙側輸卵管卵巢切除術之婦女的荷爾蒙治療,可能可以提供緩解熱潮紅等效益,而這與心血管疾病風險可能有關。
  
  在這篇研究中,檢視了平均年齡71.5歲的7,977名婦女— 6% (502人)有糖尿病、18% (1,441人)有雙側輸卵管卵巢切除術史。患有糖尿病的502人中,20% (101人)曾經進行卵巢切除術,進行過卵巢切除術的婦女比較可能使用荷爾蒙治療,而那些糖尿病患者比較不可能服用荷爾蒙。
  
  在平均追蹤15年間,共有4,797名婦女死亡,其中1,638人死於心血管疾病。
  
  CVD死亡率與沒有糖尿病者(不論有沒有進行卵巢切除術)相似(沒有糖尿病也沒有進行卵巢切除術者為12.9/1000;沒有糖尿病但有進行卵巢切除術者為12.7/1000 )。整體而言,對所有的女性糖尿病患者,不論有無進行卵巢切除術,其CVD死亡率上升(P < .001)。
  
  對於有糖尿病且未切除卵巢者,心血管原因死亡的校正風險比(HR)為1.95 (相較於沒有糖尿病或沒有進行卵巢切除術的婦女) ,對於有糖尿病且有進行雙側輸卵管卵巢切除術,HR是2.56,不過,這兩組之間的差異並未達統計上的顯著意義(P = .12)。
  
  整體而言,雙側輸卵管卵巢切除術與CVD死亡率無關(HR, 1.05),糖尿病-卵巢切除術情況與荷爾蒙治療之間也無顯著的相互影響(P = 0.34)。針對45歲以上與45歲以下婦女進行的分析中,不論其停經年齡,糖尿病者的CVD死亡率增加。
  
  不過,在第二型糖尿病者中,在45歲之前進行過雙側輸卵管卵巢切除術者的CV死亡率比未切除卵巢者增加(HR, 2.75;P = 0.012),而在45歲之後才進行此手術者,則與未切除卵巢者沒有差異(HR, 0.94,P = .86)。
  
  Appiah博士表示,儘管其他研究人員已經提出,進行過雙側輸卵管卵巢切除術之婦女的CVD風險上升,或許可用雌激素不足來解釋,但有新證據顯示,婦女在年輕時進行卵巢切除術等手術傾向會有心血管疾病家族史,且在進行手術前就有長期之不良的心血管風險因素。
  
  他表示,進行子宮切除術治療功能障礙性子宮出血的婦女,傾向比較年輕且有良性卵巢囊腫,會影響進行雙側輸卵管卵巢切除術的決定。這些婦女可能有多囊性卵巢症候群,是胰島素阻抗、糖尿病與CVD的高風險組,可能因此而使這些婦女風險上升。
  
  另外,Appiah博士指出,過去廿年來,選擇進行雙側輸卵管卵巢切除術者大幅度下降,因為美國婦產科醫學會認為,對於卵巢癌遺傳風險並未增加的停經前婦女,強烈考慮保留正常的卵巢。
  
  我們的結果與這個建議一致,第二型糖尿病婦女與年輕時進行過雙側輸卵管卵巢切除術者的CVD風險增加,還需要後續研究。
  
  資料來源:http://www.24drs.com/
  
  Native link:Ovary Removal Doesn't Cut CVD Risk in Women With Diabetes

Ovary Removal Doesn't Cut CVD Risk in Women With Diabetes

By Miriam E Tucker
Medscape Medical News

A history of bilateral salpingo-oophorectomy does not reduce the odds of death from cardiovascular disease among postmenopausal women with type 2 diabetes, although there may be an association between oophorectomy and CVD in women 45 and younger, a new study suggests.

The findings were published online October 12 in Diabetes Care by Duke Appiah, PhD, of the University of Minnesota, Minneapolis, and colleagues.

The data, from a subset of 7977 women who participated in a larger investigation of osteoporotic fractures, suggest that hyperandrogenemia is not a primary explanation for why women with type 2 diabetes are more likely to develop heart failure and to die of a cardiovascular event than are either women without diabetes or men of the same age, with or without diabetes, the authors say.

The finding of an association between oophorectomy and cardiovascular disease in younger women doesn't undercut that interpretation, Dr Appiah told Medscape Medical News.

"Our previous work and studies by others have shown that the overall association of bilateral salpingo-oophorectomy with cardiovascular disease seems to be driven by oophorectomy performed at an earlier age."

Thus, oophorectomy "may not independently predispose to incident cardiovascular disease, and our analysis suggests that the positive associations of ovarian removal with cardiovascular disease may instead be a reflection of adverse cardiovascular health among those women who undergo oophorectomy at a young age," Dr Appiah noted.

The study findings have several clinical implications, he said.

"First, they do not provide support for the opinion that bilateral salpingo-oophorectomy negatively affects cardiovascular health directly. Second, the lack of benefit of bilateral salpingo-oophorectomy for women with diabetes suggests that treatment of their hyperandrogenism is unlikely to improve their cardiovascular health."

He added, "Our results do not challenge the current idea that hormone therapy for women undergoing bilateral salpingo-oophorectomy at an earlier age may provide benefits such as relief from hot flashes, which have been linked to cardiovascular disease risk."

Diabetes Elevates CVD Risk, Regardless of Oophorectomy

In the study 7977 women with a mean age of 71.5 years at baseline were examined — 6% (502) had diabetes and 18% (1441) had a history of bilateral salpingo-oophorectomy. Among the 502 with diabetes, 20% (101) had had an oophorectomy. The women with oophorectomy were more likely to use hormone therapy, while those with diabetes were less likely to take hormones.

A total of 4797 women died over a mean follow-up of 15 years, including 1638 attributed to cardiovascular disease.

The rate of CVD mortality was similar among those without diabetes regardless of whether or not they had oophorectomy (12.9 per 1000 for women with neither compared with 12.7 per 1000 for those with no diabetes but who underwent oophorectomy).

Overall, CVD mortality was elevated for all the women with diabetes, regardless of oophorectomy status (P<.001).

For those with diabetes and intact ovaries, the adjusted hazard ratio (HR) for CV death was 1.95 (compared with women without diabetes or oophorectomy) and for those diabetics who also underwent bilateral salpingo oophorectomy, it was 2.56, but the difference between these two groups wasn't statistically significant (P=.12).

Overall, bilateral salpingo-oophorectomy was not associated with CVD mortality (HR, 1.05), and there was no significant interaction between diabetes-oophorectomy status and hormone therapy (P = 0.34).

Link Between Oophorectomy and CVD Death Seen in Younger Women

In the analysis examining women older than 45 years vs those aged 45 or younger, CVD mortality was increased among those with diabetes regardless of age at menopause.

However, among just those with type 2 diabetes, CV death was increased in those who had bilateral salpingo-oophorectomy before or at age 45 compared with those with intact ovaries (HR, 2.75; P = 0.012), whereas there was no difference among those who had the surgery after age 45 compared with those with diabetes who had intact ovaries (HR, 0.94, P = .86).

Dr Appiah told Medscape Medical News that although other investigators have proposed that the elevated CVD risk among women who have bilateral salpingo-oophorectomy may be explained by estrogen deficiency, there is emerging evidence that women who undergo such oophorectomy at an earlier age tend to have a family history of CVD and adverse CV risk factors long before undergoing the procedure, which may be performed for a variety of reasons.

Women who have hysterectomy for dysfunctional uterine bleeding tend to be younger and have benign ovarian cysts that might influence the decision for bilateral salpingo-oophorectomy. These women may have polycystic ovary syndrome, a high-risk group for insulin resistance, diabetes, and CVD, which may be driving the elevated risk among this group of women, he said.

And, Dr Appiah pointed out, elective bilateral salpingo-oophorectomy has declined dramatically in the past 2 decades since the American College of Obstetricians and Gynecologists recommended that strong consideration be made for retaining normal ovaries in premenopausal women who are not at increased genetic risk of ovarian cancer.

"Our results are in keeping with this recommendation. The elevated risk for CVD among women with type 2 diabetes and those who have bilateral salpingo-oophorectomy at an early age requires further study."

The study from which these data were obtained was supported by the National Institutes of Health. Dr Appiah and his coauthors have no relevant financial relationships.

Diabetes Care. Published online October 12, 2015.

    
相關報導
單靠篩檢與治療無法預防第二型糖尿病
2017/1/12 上午 11:07:07
別老是坐著 少坐一點對糖尿病有好處
2016/12/9 上午 10:05:25
Metformin失敗之後 延遲強化治療常見
2016/8/31 下午 01:57:15

上一頁
   1   2   3   4   5   6   7   8   9   10  




回上一頁