No increased arterial stiffness after premenopausal risk-reducing salpingo-oophorectomy (RRSO).

Jeanine E Roeters van Lennep, Encarna B Gomez Garcia, Lieke P V Berger, Marijke R Wevers, Marian J E Mourits, Constantijne H Mom, Eleonora B L van Dorst, Joanne A de Hullu, Helena C van Doorn, Lara Terra, Maarten J Beekman, Maartje J Hooning, J Margriet Collée, Flora E van Leeuwen, Marc van Beurden, Katja N Gaarenstroom, Brigitte F M Slangen, Angela H E M Maas, Margreet G E M Ausems, Klaartje van Engelen, Lizet E van der Kolk, Christi J van Asperen, Bernadette A M Heemskerk-Gerritsen

Journal: Maturitas 2025;197():108265

PMID: 40262388

Full Text on Elsevier Science View on PubMed

Abstract

OBJECTIVE

Women at high familial risk of ovarian cancer are recommended to undergo premenopausal risk-reducing salpingo-oophorectomy (RRSO). The procedure leads to immediate surgical menopause, and while early natural menopause is associated with an increase in the risk of cardiovascular disease (CVD), evidence on CVD risk after surgical menopause is inconsistent.

MAIN OUTCOME MEASURES

To investigate the long-term CVD risk after surgical menopause we conducted a cross-sectional study comparing a group of women who underwent a premenopausal RRSO (≤45 years) with a group who underwent postmenopausal RRSO (≥54 years). We assessed arterial stiffness, measured by pulse wave velocity (PWV). Increased PWV has been shown to be an independent predictor for CVD. Age differences between the pre- and postmenopausal RRSO groups were accounted for by restricting analyses to women aged 60-70 at study visit (n = 307). Within the premenopausal RRSO group (n = 461), we also examined the effect of timing of premenopausal RRSO on PWV (RRSO<41 vs RRSO 41-45 years). In addition, we assessed the association between PWV and coronary artery calcium (CAC) in women who underwent premenopausal RRSO.

RESULTS

In women aged 60-70 at study visit, PWV levels were significantly lower in the premenopausal RRSO group compared with the postmenopausal RRSO group (β: -0.87, 95 % CI, -1.45, -0.28 for PWV level; RR: 0.47, 95 % CI, 0.24, 0.93 for being in the upper PWV quintile). The timing of premenopausal RRSO did not influence PWV. Among all women who underwent premenopausal RRSO, having a PWV in the upper quintile was an independent predictor of the presence of CAC (RR 1.32, 95 % CI, 1.04-1.68 for CAC > 0).

CONCLUSION

Our study does not support a long-term adverse effect of premenopausal RRSO on arterial stiffness, but increased arterial stiffness is associated with the presence of CAC in women who have undergone a premenopausal RRSO.

CLINICAL TRIAL REGISTRATION

The pre-registered clinical trial number is .

Address: Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands. Electronic address: [email protected].; Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands.; Department of Internal Medicine, Erasmus MC Cardiovascular Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands.; Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.; Department of Gynaecological Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands.; Department for Gynaecologic Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.; Department for Gynaecology, Radboud University Medical Center, Nijmegen, the Netherlands.; Department of Gynaecologic Oncology, University Medical Center Utrecht, Utrecht, the Netherlands.; Department of Gynaecological Oncology, Amsterdam University Medical Center, Amsterdam, the Netherlands.; Department of Obstetrics and Gynaecology, Maastricht University Medical Center, Maastricht, the Netherlands.; Department of Gynaecologic Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.; Department of Gynaecology, Leiden University Medical Center, Leiden, the Netherlands.; Department of Human Genetics, Amsterdam University Medical Center, Amsterdam, the Netherlands.; Family Cancer Clinic, The Netherlands Cancer Institute, Amsterdam, the Netherlands.; Department of Clinical Genetics, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.; Department of Clinical Genetics, Radboud University Medical Center, Nijmegen, the Netherlands.; Department of Genetics, University Medical Center Utrecht, Utrecht, the Netherlands.; Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.; Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, the Netherlands.; Department for Clinical Genetics, Leiden University Medical Center, Leiden, the Netherlands.; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands.

DOI: 10.1016/j.maturitas.2025.108265

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MeSH Terms: Adult, Aged, Female, Humans, Middle Aged, Cardiovascular Diseases, Cross-Sectional Studies, Ovarian Neoplasms, Postmenopause, Premenopause, Pulse Wave Analysis, Salpingo-oophorectomy, Vascular Stiffness