Oophorectomy linked to higher risk of heart failure in women

Oophorectomy linked to higher risk of heart failure in women

Women of childbearing age who had both ovaries removed in a procedure called bilateral oophorectomy were more likely to develop heart failure later in life, according to a study presented at the annual scientific meeting of the American College of Cardiology (ACC.25).

A bilateral oophorectomy is often recommended to treat and, in some cases, prevent certain health problems, including endometriosis, pelvic inflammatory disease, heavy bleeding, and ovarian cancer. The new study highlights the potential and unique role this procedure could play in increasing cardiovascular risk because it abruptly stops the production of estrogen and other hormones, and depending on timing, may induce early menopause, which researchers may differentiate from other causes of early menopause.

We know that sex hormones, including estrogen and progesterone levels, play a critical role in cardiovascular risk. Our study shows that there is a connection between the removal of ovaries and the future development of heart failure. We believe this may be due to early menopause. However, in this case, early menopause results from planned surgical removal of the ovaries, which is different from other causes such as occult infections, autoimmune diseases or unexpected genetic disorders. By understanding this, we can anticipate and treat potential complications, particularly cardiovascular disease. “

Narathorn Kulthamgrongsri, MD, first-year internal medicine resident, University of Hawaii, Honolulu

The study uses data from 6,814 female patients who participated in the National Health and Nutrition Examination Survey (NHANES) between 2017 and 2023. The average age of the women who underwent the procedure was 43.6 years and 57 years at the diagnosis of heart failure. Age at oophorectomy and heart failure were self-reported.

Compared to women in the general population who have their ovaries intact, those who underwent bilateral oophorectomy had a 1.5-fold increased risk of developing heart failure after adjusting for race, age, gender, diabetes, smoking status, and high cholesterol. White women and those who had their ovaries removed at a younger age had an even higher, twofold increased risk of heart failure.

“The age at which a woman has her ovaries removed [impacts] her risk of heart failure,” Kulthamrongsri said.

According to researchers, their findings also underscore the need to integrate cardiovascular risk discussions and closer cardiac monitoring for women considering oophorectomy before natural menopause (defined as no time for a full year), which, on average, usually occurs at age 51.

"Women must do what is medically necessary regarding oophorectomy, but our findings suggest that they should have an informed discussion with their healthcare team about monitoring their cardiovascular health and managing potential risk factors for heart failure, including adopting a healthy lifestyle and perhaps asking about a potential role of hormone replacement therapy," Kulthamongongsri said.

While some women may not have a choice when undergoing this procedure, an informed discussion about the best timing based on their age and health is important to discuss and weigh the potential additional cardiovascular risks. This may be particularly important for white women, who appear to be at much higher risk of heart failure.

"This racial disparity is surprising because previous research shows that black individuals have a higher prevalence of poorer heart failure outcomes due to higher risks of hypertension, diabetes and obesity. In contrast, white individuals are more likely to develop from ischemic heart disease and tend to have more life disorders that develop with property decline and physical inactivity. Menopause associated with myocardial infarction or other etiologies in which sex hormones play a crucial role," Kulthamrongsri said.

The study is limited in that it relied on self-reported data and researchers could only examine the lifetime risk of heart failure, rather than determining whether an oophorectomy was more likely to lead to heart failure within a specific period of time after the procedure.

However, Kulthamgrongsri said the findings add to growing evidence that early surgical menopause could have long-term cardiovascular consequences, particularly an increased risk of heart failure. This concern is particularly relevant given the number of women undergoing oophorectomy procedures.

Further studies should be conducted to validate these results with larger global datasets. Future research should also investigate possible preventive solutions, including cardiovascular screening recommendations and the use of prophylactic cardiac medications.

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