title: The effect of hysterectomy or levonorgestrel-releasing intrauterine system on cardiovascular disease risk factors in menorrhagia patients: a 10-year follow-up of a randomised trial.
abstract: OBJECTIVE
  To compare, whether women with menorrhagia, treated with either hysterectomy or LNG-IUS, differ in their cardiovascular risk profile during 10-year follow-up.
  
  
  METHODS
  A total of 236 women were randomized to treatment by hysterectomy (n=117) or LNG-IUS (n=119). Their cardiovascular risk factors were analyzed at baseline, at 5 years, and at 10 years. As 55 originally randomized to the LNG-IUS group had hysterectomy during the follow-up, all analyzes were performed by actual treatment modality.
  
  
  METHODS
  Waist circumference, body-mass index (BMI), blood pressure, and the levels of blood lipids, serum high-sensitivity CRP (hsCRP) and tumor necrosis factor alpha (TNF-α) were measured, and the use of medication for hypertension, diabetes, hypercholesterolemia, and ischemic heart disease was analyzed.
  
  
  RESULTS
  After 5 years, an increase in the use of diabetes medication during the follow-up was only detected in the hysterectomy group (from 1.7% to 6.7%, P=0.008 vs from 5.1% to 8.4%, P=0.08), as well as they had significantly higher serum levels of TNF-α (108.59 pg/ml vs 49.02 pg/ml, P=0.001) and hsCRP (1.55 μg/ml vs 0.78 μg/ml, P=0.038) at 5- and 10-years. There was no difference between the groups in the use of cardiovascular medication, neither was there difference in blood pressure, waist circumference, BMI, or concentrations of blood lipids.
  
  
  CONCLUSIONS
  Hysterectomy seems to be associated with increased levels of serum inflammatory markers and increased diabetes medication, which in turn, may predispose individual to future cardiovascular events.
authors.affiliation: Department of Obstetrics and Gynaecology, Helsinki University Hospital, Helsinki, Finland. satu.heliovaara-peippo@helsinki.fi
authors.forename: S
authors.initials: S
authors.lastname: Heliövaara-Peippo
authors.forename: R
authors.initials: R
authors.lastname: Oksjoki
authors.forename: K
authors.initials: K
authors.lastname: Halmesmäki
authors.forename: R
authors.initials: R
authors.lastname: Kaaja
authors.forename: J
authors.initials: J
authors.lastname: Teperi
authors.forename: S
authors.initials: S
authors.lastname: Grenman
authors.forename: A
authors.initials: A
authors.lastname: Kivelä
authors.forename: H-M
authors.initials: HM
authors.lastname: Surcel
authors.forename: E
authors.initials: E
authors.lastname: Tomas
authors.forename: M
authors.initials: M
authors.lastname: Tuppurainen
authors.forename: R
authors.initials: R
authors.lastname: Hurskainen
authors.forename: J
authors.initials: J
authors.lastname: Paavonen
mesh_terms: D000328:Adult; D002097:C-Reactive Protein / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology*; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007044:Hysterectomy / Q000009:adverse effects*; D007249:Inflammation / Q000097:blood / Q000150:complications*; D007436:Intrauterine Devices, Medicated; D016912:Levonorgestrel / Q000009:adverse effects* / Q000627:therapeutic use; D008595:Menorrhagia / Q000097:blood / Q000628:therapy*; D008875:Middle Aged; D011372:Progestins / Q000009:adverse effects* / Q000627:therapeutic use; D012307:Risk Factors; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D007004:Hypoglycemic Agents; D011372:Progestins; D014409:Tumor Necrosis Factor-alpha; D016912:Levonorgestrel; D002097:C-Reactive Protein