Development of cardiovascular risk factors in women with a BRCA1/2 pathogenic variant within five years after tubo-ovarian cancer risk reduction in the TUBA study

Abstract

Objectives: The effects of risk-reducing salpingo-oophorectomy on the development of cardiovascular risk factors in women with BRCA1/2 pathogenic variants are unknown. We compared the development of cardiovascular risk factors 5 years post-surgery between participants who had risk-reducing salpingo-oophorectomy with and without hormonal replacement therapy and participants who had risk-reducing salpingectomy.

Study design: Eligible participants with a BRCA1/2 pathogenic variant from the TUBA study were longitudinally followed and categorized into three groups: (1) salpingectomy without subsequent oophorectomy within 5 years, (2) salpingo-oophorectomy with hormonal replacement therapy (use ≥3 years), (3) salpingo-oophorectomy without hormonal replacement therapy (use <3 years).

Main outcome measures: Development of cardiovascular risk factors between baseline and 5 years after salpingo-oophorectomy or salpingectomy.

Results: Of the 400 participants, 258 (64.5%) had salpingectomy, 93 (23.3%) had salpingo-oophorectomy and used hormonal replacement therapy ≥3 years, and 49 (12.2%) used it for <3 years. At 5-year follow-up, the cardiovascular risk factor hypercholesterolemia (increased LDLc) was observed more often after salpingo-oophorectomy with (18.8%, p ≤0.001) and without (17.1%, p = 0.03) hormonal replacement therapy compared with the salpingectomy group (5.7%). Larger proportions of participants after salpingo-oophorectomy with (47.1%) and without (50.0%) hormonal replacement therapy experienced an increase in the number of risk factors present compared with participants after salpingectomy (24.5%; p = 0.009, p = 0.02, respectively).

Conclusions: Overall, only a small proportion of the study population developed cardiovascular risk factors within five years after salpingo-oophorectomy. However, participants developed the risk factor hypercholesterolemia more after salpingo-oophorectomy (irrespective of use of hormonal replacement therapy) compared with after salpingectomy.

Trial registration: NCT02321228.

Keywords: BRCA1; BRCA2; Cardiovascular risk; Hormonal replacement therapy; Ovarian cancer; Prevention.