Can arcuate artery morphology predict mortality from ischaemic heart disease?

The degree of atherosclerosis in the uterine and cardiac vasculature are closely related. Examination of the uterine vessels at the time of hysterectomy might therefore indicate that individual's risk of death from ischaemic heart disease (IHD). A pilot study was performed to see if women with severe coronary artery atherosclerosis (CAA) at post mortem had more arcuate artery intimal damage at the time of their hysterectomy than controls.

Post mortem reports from women who had died in 1993-1997 were studied to identify women who had previously undergone hysterectomy in the same hospital. Cases (those with severe CAA) and controls (without CAA) were matched for age of death and hysterectomy. Stored myometrial sections were re-cut and stained with elastic van Gieson. The medial thickness and intimal changes of the arcuate arteries were analysed using computerised morphology and compared using the paired t-test.

From all the post mortem reports studied, only six pairs fitted the strict criteria for analysis. The cases showed a trend towards smaller medial area than controls (-11.3%, 95% CI -27.1 to +4.5, P = 0.1), but there was no difference in the degree of intimal damage or lumen occlusion. The two cases who had premenopausal hysterectomies (and deaths at under 60 years old) both had severe intimal damage and marked lumen occlusion whilst their controls had neither.

Arcuate artery morphology at the time of hysterectomy may be predictive of death from IHD. A larger case-control study is both feasible and promising.