Impact of endometrial cancer surgery on the development of cardiovascular risk factors in women under 51.

Abstract

e17645 Background: In younger patients, the rising burden of endometrial cancer (EC) intersects with cardiovascular (CV) disease, now a predominant driver of non-cancer mortality in gynecologic oncology. Abrupt loss of ovarian function after hysterectomy with bilateral salpingo-oophorectomy (BSO) may unmask or accelerate cardiometabolic vulnerability. Here, we assess the incidence of new CV risk factors among women under 51 years of age who underwent BSO for EC compared to those who underwent BSO for benign indications. Methods: Patients under 51 years of age who underwent hysterectomy with BSO at a single academic center between January 1, 2017 to September 1, 2023 were identified from the electronic health record. They were classified into an exposure cohort of those surgically treated for EC and a comparison cohort of those who underwent the same procedure for borderline pathology or risk-reducing indications. Demographic and clinical variables, including age at surgery, body mass index (BMI), smoking status, and baseline CV history, were abstracted. The primary endpoint was incident or progressive CV risk, defined as new-onset hypertension, hyperlipidemia, or atrial fibrillation, or initiation/intensification of antihypertensive, lipid-lowering, antiplatelet (aspirin), or anticoagulant therapy. Associations between EC status and the primary endpoint were evaluated using multivariable models adjusted for age, BMI, and smoking. A p-value <0.05 was considered statistically significant. Analyses were performed using SAS version 9.4 (SAS Institute, Cary, NC). Results: In our cohort of 399 patients, 281 (70.4%) carried an EC diagnosis and 118 (29.6%) a benign diagnosis. EC patients were more likely to be younger, belong to a minority race/ethnicity, have a higher BMI, and smoke (p<0.01). EC patients were more likely to develop a new CV comorbidity, with 83 (29.6%) of the EC group diagnosed at a median time of 19.4 months and 25 (21.2%) of non-EC patients diagnosed at 32.9 months (p<0.05). There was a greater 5-year cumulative incidence of the primary outcome in EC patients (46%, 95% CI: 38-55%) compared with non-EC patients (30%, 95% CI: 22-41%). Gray’s test confirmed a statistically significant difference in the cumulative incidence functions between groups (p=0.01). After adjustment, EC patients had a 51% increase in risk of the primary outcome, though this did not reach statistical significance (adjHR 1.51, 95% CI: 0.95-2.40, p=0.08). Among patients who developed at least one new CV risk factor, 49% of EC patients had an increase in anti-hypertensive or lipid-lowering therapy compared to 0% in the non-EC group (p<0.01). Conclusions: Young patients with EC had a higher and earlier burden of new CV risk factors than those undergoing surgery for benign indications. This highlights the need to incorporate systematic CV risk assessment as an integral part of routine EC surveillance.