Design: A retrospective cohort study was developed from IBM MarketScan® Research Databases- a fully adjudicated, deidentified database from ICD9/10 and CPT claims collected by health plans- comparing cardiometabolic event prevalence and incidence in patients with fibroids.
Setting: National database review
Patients or Participants: The cohort included: female sex, aged 18-55, fibroid diagnosis in 2010, and continuous enrollment through 2021 in MarketScan®; n= 20525.
Interventions: Patients self-selected for surgical management of fibroids in 2010 including no surgery (n=15551, 75.8%), hysterectomy (n=4045, 19.7%), or myomectomy (n=929, 4.5%).
Measurements and Main Results: Chi-squared analyses were performed to compare patients with no surgery, hysterectomy, or myomectomy using SAS v9.4. Patients with prevalent disease were excluded in analyses of incident disease. Baseline prevalence of coronary artery disease (CAD) (1.4%NS, 1.7%H, 1.1%M), cerebrovascular disease (CVD) (1.2%NS, 1.2%H, 1.4%M), and diabetes mellitus (DM) (6.4%NS, 7.2%H, 5.4%M) was not different between the 3 intervention groups. At baseline, groups had significantly different rates of hypertension (HTN) (23.5%NS, 30.1%H, 20.6%M, p<0.0001) and hyperlipidemia (HLD) (20.3%NS, 20.9%H, 16.3%M, p=0.006). Incidence of CAD (8.8%NS, 9.8%H, 5.6%M, p=0.0003), HTN (43.2%NS, 46.7%H, 38.2%M, p<0.0001), CVD (8.0%NS, 9.0%H, 6.3%M, p=0.016), DM (18.0%NS, 20.5%H, 16.7%M, p=.001) and HLD (56.7%NS, 60.7%H, 46.1%M, p<0.0001) were significantly different with myomectomy having lowest rates of disease incidence and hysterectomy having the highest.
Conclusion: Patients with fibroids who underwent myomectomy had significantly lower rates of developing HTN, CAD, CVD, DM, and HLD than patients who had a hysterectomy or no surgery. Patients who underwent hysterectomy had the highest incidence of all analyzed cardiometabolic outcomes. While additional study is needed to assess contribution of comorbid factors to cardiometabolic outcomes, myomectomy may have cardio-protective effects in management of fibroids.
Olson, SL*. Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, Michel, R. Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, Yanek, L. General Internal Medicine, Johns Hopkins Medicine, Baltimore, MD, Borahay, M. Gynecology and Obstetrics, Division of Minimally Invasive Gynecologic Surgery, Johns Hopkins Hospital, Baltimore, MD
