Uterine artery atherosclerotic disease: histologic features and clinical correlation

To determine whether uterine artery atherosclerosis is associated with known cardiovascular risk factors in women undergoing hysterectomy.

Seventy-four women undergoing hysterectomy between September 1995 and March 1996 were evaluated. Following hysterectomy, samples of the uterine artery were collected for histologic evaluation. Plaque complexity and histologic measurements were compared with regard to known cardiovascular risk factors.

Among the 59 premenopausal women, 55.9% had intimal thickening 40.7% had simple plaques, and 3.7% had complex lesions in the uterine artery samples. Among postmenopausal women, 40% had intimal fibrosis, 20% had simple plaques, and 40% had complex lesions. Postmenopausal status was correlated strongly with the presence of advanced atherosclerotic disease (P < .001). Postmenopausal women had significantly greater intimal area (P = .01), intimal area/medial area (P = .002), intimal area/vessel area (P = .002), maximal intimal thickness/medial thickness (P = .01), and significantly less medial thickness (P < .001). A significant linear correlation existed between age and the intimal/medial ratio among premenopausal women (P = .04) and postmenopausal women (P = .01). Patients with electrocardiogram (ECG) abnormalities had significantly greater intimal/medial area as well (P = .02). Hypertension was associated with complex lesions among the postmenopausal patients (P = .01). Preoperative cholesterol levels greater than 200 mg/dL were associated with greater intimal thickness (P = .05) and intimal thickness/medial thickness (P = .03).

The severity of uterine artery atherosclerosis is significantly correlated with known risk factors for cardiovascular disease: increasing age, postmenopausal status, ECG abnormalities, and hypertension. Uterine artery histologic analysis may provide a means of assessing the degree of atherosclerosis in other, critical, vascular beds.