Highlights
- •Women with BRCA mutations undergoing RRBSO were less likely to be diagnosed with predisposing conditions for CVD.
- •There was also a non-significant trend of lower use of cardioprotective medications among these women.
- •However, there was no reduced hazard of CVD among these women compared to women without mutations undergoing oophorectomy.
- •The hazard of CVD was higher among these women compared to women without mutations and intact ovaries.
- •We expect CVD prevention can be improved by optimizing diagnosis of predisposing conditions and preventive strategies.
Abstract
Objective
Examine the risk of cardiovascular disease (CVD) following risk reducing bilateral
salpingo-oophorectomy (RRBSO) among women with BRCA mutations.
Methods
In this retrospective population-based study in British Columbia, Canada, between
1996 and 2017, we compared the risk of CVD among women with known BRCA mutations who underwent RRBSO before the age of 50 (n = 360) with two groups of age-matched women without known BRCA mutations: 1) women who underwent bilateral oophorectomy (BO) for benign conditions
(n = 3600); and, 2) women with intact ovaries who had hysterectomy or salpingectomy
(n = 3600). Our primary outcome was CVD (a composite (any of) myocardial infarction,
heart failure, and/or cerebrovascular disease). Secondary outcomes included a diagnostic
code for predisposing conditions (hypertension, dyslipidemia, and/or diabetes mellitus),
and use of cardioprotective medications (statins and/or beta-blockers).
Results
We report no significant increased risk for CVD between women with BRCA mutations and women who underwent BO (aHR = 1.08, 95%CI: 0.72–1.62), but women with
BRCA mutations were less likely to be diagnosed with predisposing conditions (aHR = 0.69,
95%CI: 0.55–0.85). Compared to women without BRCA mutations with intact ovaries who underwent hysterectomy or salpingectomy, women
with BRCA mutations had significantly increased risk for CVD (aHR = 1.82, 95%CI: 1.18–2.79)
and were less likely to be diagnosed with predisposing conditions (aHR = 0.78, 95%CI:
0.62–0.97) and to fill cardioprotective medications (aHR = 0.88, 95%CI: 0.64–1.22).
Conclusion
Our results suggest an opportunity for improved prevention of CVD in women with BRCA mutations after prophylactic oophorectomy. Despite the observed lower prevalence
of predisposing conditions for CVD and lesser use of cardioprotective medications,
this population did not have a lower rate of CVD.
Keywords
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Article info
Publication history
Published online: July 01, 2021
Accepted:
June 23,
2021
Received in revised form:
June 21,
2021
Received:
March 1,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
