Risk Assessment of Coronary Artery Disease Due to Hysterectomy in Type 2 Diabetic Women in Premenopausal Age Group

Background: Women with diabetes mellitus have twice the risk of myocardial infarction (MI) than non-diabetic women of the same age group and bearing the risk of MI in a non-diabetic male of the same age.

Aim: The present study aimed to determine the impact of hysterectomy in women with type 2 diabetes mellitus in premenopausal age, on the risk of CAD.

Methods: A total of 181 type 2 diabetic women who underwent exercise treadmill ECG testing in the hospital during a 30 months period were studied. Based on an arbitrary cut off age of 48 yrs subjects were assigned in group 1: age < 48 yrs (premenopausal) and group 2: age
48 years (postmenopausal). Based on exercise treadmill ECG results, they were sub grouped as without CAD (treadmill ECG test negative) and with CAD (treadmill ECG test positive).

Results: Age, duration of diabetes, hypertension and CAD were significantly more in postmenopausal group (p<0.05). Age, HDL-cholesterol and hysterectomy were significantly (p< 0.05) associated with premenopausal CAD. In postmenopausal CAD subgroup age, duration of diabetes, hypertension, HDL-cholesterol, sedentary physical activity and hysterectomy were significantly higher (p<0.05). In the multivariate analysis, hysterectomy was strongly associated (OR = 7.73, p = 0.016) with premenopausal CAD.

Conclusion: The study projects hysterectomy as a high risk factor for the CAD in premenopausal type 2 diabetics. More information from prospective long-term clinical trials targeted to answer the questions regarding the loss of premenopausal protection of CAD in diabetes and the optimal treatment strategies for both premenopausal diabetic women and CAD will help to guide therapy in the future.