Hysterectomy, non-malignant gynecological diseases, and the risk of incident hypertension: The E3N prospective cohort

Anne-Laure Madika (1, 2) , Conor James Macdonald (3) , Amandine Gelot (3) , Sixtine Hitier (4, 5) , Claire Mounier-Vehier (1, 2) , Guillaume Beraud (1, 6) , Marina Kvaskoff (3) , Marie-Christine Boutron-Ruault (3) , Fabrice Bonnet (4, 5)

1 METRICS - Evaluation des technologies de santé et des pratiques médicales - ULR 2694
2 Institut Coeur Poumon [CHU Lille]
3 CESP - Centre de recherche en épidémiologie et santé des populations
4 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
5 UR - Université de Rennes
6 CHU de Poitiers - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital

Objectives: While it has been reported that women with uterine fibroids or endometriosis are commonly overweight and hypertensive, the association between non-malignant gynecological diseases and the risk of hypertension has been little studied prospectively. The aim of this study was to investigate in a large French cohort of women whether a history of hysterectomy, uterine fibroids, or endometriosis was prospectively related to an increased risk of incident hypertension. Study design: We analyzed 50,286 women from the E3N cohort who were free of hypertension at baseline, with a median follow-up of 16.4 years. Main outcome measures: Gynecological diseases were based on self-report. Cox proportional hazards models with age as the timescale were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Covariates included smoking status, body mass index (BMI), physical activity, and hormonal factors. Results: A total of 12,073 women (24%) developed hypertension during follow-up. Women with a history of hysterectomy had an increased risk of incident hypertension, which persisted after adjustment for potential confounding factors (adjusted HR=1.18, 95% CI 1.12-1.24). Risk was similar in women with hysterectomy with or without oophorectomy. Risk of hypertension was higher in women with a history of endometriosis (HRendometriosis 1.19, 95%CI 1.11-1.22) or uterine fibroids (HRfibroids 1.18, 95%CI 1.13-1.22), irrespective of hysterectomy. Associations were similar after further adjustment for BMI. Conclusions: Hysterectomy and non-malignant gynecological diseases were associated with an increased risk of hypertension in this large prospective study. Women with these conditions may benefit from blood pressure monitoring. ClinicalTrials.gov identifier: NCT03285230

Mots clés: Endometriosis; Uterine fibroids; Hypertension; Hysterectomy; Epidemiology

Domaines: Sciences du Vivant [q-bio]

Anne-Laure Madika, Conor James Macdonald, Amandine Gelot, Sixtine Hitier, Claire Mounier-Vehier, et al.. Hysterectomy, non-malignant gynecological diseases, and the risk of incident hypertension: The E3N prospective cohort. Maturitas, 2021, 150, pp.22-29. ⟨10.1016/j.maturitas.2021.06.001⟩. ⟨hal-03336373⟩