Race and Ethnicity-Adjusted Age Recommendation for Initiating Breast Cancer Screening.

IMPORTANCE Breast cancer (BC) is the second leading cause of cancer death in women, and there is a substantial disparity in BC mortality by race, especially for early-onset BC in Black women. Many guidelines recommend starting BC screening from age 50 years; however, the current one-size-fits-all policy to start screening all women from a certain age may not be fair, equitable, or optimal. OBJECTIVE To provide race and ethnicity-adapted starting ages of BC screening based on data on current racial and ethnic disparities in BC mortality. DESIGN, SETTING, AND PARTICIPANTS This nationwide population-based cross-sectional study was conducted using data on BC mortality in female patients in the US who died of BC in 2011 to 2020. EXPOSURES Proxy-reported race and ethnicity information was used. The risk-adapted starting age of BC screening by race and ethnicity was measured based on 10-year cumulative risk of BC-specific death. Age-specific 10-year cumulative risk was calculated based on age group-specific mortality data without modeling or adjustment. MAIN OUTCOMES AND MEASURES Disease-specific mortality due to invasive BC in female patients. RESULTS There were BC-specific deaths among 415 277 female patients (1880 American Indian or Alaska Native [0.5%], 12 086 Asian or Pacific Islander [2.9%], 62 695 Black [15.1%], 28 747 Hispanic [6.9%], and 309 869 White [74.6%]; 115 214 patients died before age 60 years [27.7%]) of any age in the US in 2011 to 2020. BC mortality per 100 000 person-years for ages 40 to 49 years was 27 deaths in Black females, 15 deaths in White females, and 11 deaths in American Indian or Alaska Native, Hispanic, and Asian or Pacific Islander females. When BC screening was recommended to start at age 50 years for all females with a 10-year cumulative risk of BC death of 0.329%, Black females reached this risk threshold level 8 years earlier, at age 42 years, whereas White females reached it at age 51 years, American Indian or Alaska Native and Hispanic females at age 57 years, and Asian or Pacific Islander females 11 years later, at age 61 years. Race and ethnicity-adapted starting ages for Black females were 6 years earlier for mass screening at age 40 years and 7 years earlier for mass screening at age 45 years. CONCLUSIONS AND RELEVANCE This study provides evidence-based race-adapted starting ages for BC screening. These findings suggest that health policy makers may consider a risk-adapted approach to BC screening in which individuals who are at high risk are screened earlier to address mortality due to early-onset BC before the recommended age of mass screening

Familial risk of early and late onset cancer : nationwide prospective cohort study.

To determine whether familial risk of cancer is limited to early onset cases. Nationwide prospective cohort study. SETTING : Nationwide Swedish Family-Cancer Database. All Swedes born after 1931 and their biological parents, totalling >12.2 million individuals, including >1.1 million cases of first primary cancer. Familial risks of the concordant cancers by age at diagnosis. The highest familial risk was seen for offspring whose parents were diagnosed at an early age. Familial risks were significantly increased for colorectal, lung, breast, prostate, and urinary bladder cancer and melanoma, skin squamous cell carcinoma, and non-Hodgkin's lymphoma, even when parents were diagnosed at age 70-79 or 80-89. When parents were diagnosed at more advanced ages (≥ 90), the risk of concordant cancer in offspring was still significantly increased for skin squamous cell carcinoma (hazard ratio 1.9, 95% confidence interval 1.4 to 2.7), colorectal (1.6, 1.2 to 2.0), breast (1.3, 1.0 to 1.6), and prostate cancer (1.3, 1.1 to 1.6). For offspring with a cancer diagnosed at ages 60-76 whose parents were affected at age <50, familial risks were not significantly increased for nearly all cancers. Though the highest familial risks of cancer are seen in offspring whose parents received a diagnosis of a concordant cancer at earlier ages, increased risks exist even in cancers of advanced ages. Familial cancers might not be early onset in people whose family members were affected at older ages and so familial cancers might have distinct early and late onset components

Risk of Gynecological Cancers in Cholecystectomized Women: A Large Nationwide Cohort Study.

Background: Gallstones affect women more frequently than men, and symptomatic gallstones are increasingly treated with surgical removal of the gallbladder (cholecystectomy). Breast, endometrial, and ovarian cancer share several risk factors with gallstones, including overweight, obesity, and exposure to female sex hormones. We intended to assess the association between cholecystectomy and female cancer risk, which has not been comprehensively investigated. Methods: We investigated the risk of female cancers after cholecystectomy leveraging the Swedish Cancer, Population, Patient, and Death registries. Standardized incidence ratios (SIRs) adjusted for age, calendar period, socioeconomic status, and residential area were used to compare cancer risk in cholecystectomized and non-cholecystectomized women. Results: During a median follow-up of 11 years, 325,106 cholecystectomized women developed 10,431 primary breast, 2888 endometrial, 1577 ovarian, and 705 cervical cancers. The risk of ovarian cancer was increased by 35% (95% confidence interval (CI) 2% to 77%) in the first 6 months after cholecystectomy. The exclusion of cancers diagnosed in the first 6 months still resulted in an increased risk of endometrial (19%, 95%CI 14% to 23%) and breast (5%, 95%CI 3% to 7%) cancer, especially in women cholecystectomized after age 50 years. By contrast, cholecystectomized women showed decreased risks of cervical (-13%, 95%CI -20% to -7%) and ovarian (-6%, 95%CI -10% to -1%) cancer. Conclusions: The risk of ovarian cancer increased by 35% in a just short period of time (6 months) following the surgery. Therefore, it is worth ruling out ovarian cancer before cholecystectomy. Women undergoing cholecystectomy showed an increased risk of breast and endometrial cancer up to 30 years after surgery. Further evaluation of the association between gallstones or gallbladder removal on female cancer risk would allow for the assessment of the need to intensify cancer screening in cholecystectomized women

The Relationship between Management Styles and Change and Innovation Skills of Administrators in Teaching Hospitals of Shiraz University of Medical Sciences

Background: With regard to novel plans in the health sector, including “Health Sector Evolution” and changes of hospitals’ issues, change and innovation skills are considered essential for hospital administrators. This study aimed to determine the relationship between management style and change and innovation skills of administrators in Teaching Hospitals of Shiraz University of Medical Sciences in 2009. Methods: This was a cross-sectional and descriptive-analytical survey. Study samples were 9 managers and 135 headquarter staff of hospitals affiliated to Shiraz University of Medical Sciences. Data were collected using the management style questionnaire of Rensis Likert and questionnaire of change and innovation skills. Data were analyzed through SPSS16 and using descriptive statistics (frequency, percentage and mean) and analytical statistics (t-test and ANOVA .( Results: Most hospital administrators of Shiraz University of Medical Sciences had consultative management style. The majority of headquarter staff were in the age group of 20-40 years. There was a significant relationship between change and innovation skills of hospital administrators and their management styles (P<0.001). Conclusion: It seems that in order to implement the change and innovation plans in hospitals, implementing a successful participatory management style is very effective, because with honest participation, the organizational goals will be more achievable. Keywords: Management style, change and innovation skills, hospital administrators, headquarter staf

Encapsulation of orange peel oil in biopolymeric nanocomposites to control its release under different conditions

Orange peel oil (OPO) is one of the most common flavorings used in the food industry, but it is volatile under environmental conditions (the presence of light, oxygen, humidity, and high temperatures). Encapsulation by biopolymer nanocomposites is a suitable and novel strategy to improve the bioavailability and stability of OPO and its controlled release. In this study, we investigated the release profile of OPO from freeze-dried optimized nanocomposite powders as a function of pH (3, 7, 11) and temperature (30, 60, and 90 °C), and within a simulated salivary system. Finally, its release kinetics modelling was performed using experimental models. The encapsulation efficiency of OPO within the powders, along with the morphology and size of the particles, were also evaluated by an atomic force microscopy (AFM) analysis. The results showed that the encapsulation efficiency was in the range of 70–88%, and the nanoscale size of the particles was confirmed by AFM. The release profile showed that the lowest and the highest release rates were observed at the temperatures of 30 and 90 °C and in the pH values of 3 and 11, respectively, for all three samples. The Higuchi model provided the best model fitting of the experimental data for the OPO release of all the samples. In general, the OPO encapsulates prepared in this study showed promising characteristics for food flavoring applications. These results suggest that the encapsulation of OPO may be useful for controlling its flavor release under different conditions and during cooking

Gallstones, cholecystectomy and kidney cancer: observational and Mendelian randomisation results based on large cohorts.

BACKGROUND AND AIMS Gallstones (cholelithiasis) constitute a major health burden with high costs related to surgical removal of the gallbladder (cholecystectomy), generally indicated for symptomatic gallstones. The association between gallstones, cholecystectomy and kidney cancer is controversial. We comprehensively investigated this association, considering age at cholecystectomy and time from cholecystectomy to kidney cancer diagnosis, and assessing the causal effect of gallstones on kidney cancer risk by Mendelian randomisation (MR). METHODS We compared the risk of kidney cancer in cholecystectomised and non-cholecystectomised individuals (16.6 million in total) from the Swedish nationwide cancer, census, patient and death registries using hazard ratios (HRs). For two-sample and multivariable MR, we used summary statistics based on 408,567 UK Biobank participants. RESULTS During a median follow-up of 13 years, 2,627 of 627,870 cholecystectomised Swedish patients developed kidney cancer (HR=1.17, 95% CI 1.12-1.22). Kidney cancer risk was particularly increased in the first 6 months after cholecystectomy (HR=3.79, 95% CI 3.18-4.52) and in patients cholecystectomised before age 40 (HR=1.55, 95% CI 1.39-1.72). MR results based on 18.417 gallstone and 1,788 kidney cancer patients from the UK revealed a causal effect of gallstones on kidney cancer risk (9.6% risk increase per doubling in gallstone prevalence, 95% CI 1.2%-18.8%). CONCLUSIONS Both observational and causal MR estimates based on large prospective cohorts support an increased risk of kidney cancer in gallstone patients. Our findings provide solid evidence for the compelling need to diagnostically rule out kidney cancer before and during gallbladder removal, to prioritise kidney cancer screening in patients undergoing cholecystectomy in their 30s, and to investigate the underlying mechanisms linking gallstones and kidney cancer in future studies

Structural, optical and electrical properties of ZnS nanoparticles affecting by organic coating

In this study the influence of the organic polymeric coating and its concentration on the structural, optical and electrical properties of ZnS nanocrystals has been investigated. In this matter, PVP-capped ZnS nanocrystals were prepared by a simple, rapid and energy efficient microwave method. The XRD results confirmed the formation of single phase cubic nano crystalline structure. TEM images showed the formation of well isolated spherical nanoparticles with the average size of less than 5.5 nm. The presence of tensile strain in all samples was determined from Williamson-Hall analysis. The elemental compositions of Zn, S and O were quantitatively obtained from EDX analysis, where the FT-IR spectra confirmed coordination with O atoms of PVP. The band gap and absorption edge shift was determined using UV–visible spectroscopy. The PL spectra of the PVP-capped ZnS nanoparticles appeared broadened from 370 to 500 nm due to the presence of multiple emission bands attribute to the sulfur and zinc vacancies or compounded effect of PVP. The electrical property study of samples indicated the conductivity enhancement from 2.981×10-6 to 7.014 ×10-6 S/m by increasing PVP concentration. Increasing of dielectric constant and decrease in the peak value of tan δ by raising the PVP concentration were observed

Effect of dietary intervention on serum lignan levels in pregnant women - a controlled trial

<p>Abstract</p> <p>Background</p> <p>Mother's diet during pregnancy is important, since plant lignans and their metabolites, converted by the intestinal microflora to enterolignans, are proposed to possess multiple health benefits. Aim of our study was to investigate whether a dietary intervention affects lignan concentrations in the serum of pregnant women.</p> <p>Methods</p> <p>A controlled dietary intervention trial including 105 first-time pregnant women was conducted in three intervention and three control maternity health clinics. The intervention included individual counseling on diet and on physical activity, while the controls received conventional care. Blood samples were collected on gestation weeks 8-9 (baseline) and 36-37 (end of intervention). The serum levels of the plant lignans 7-hydroxymatairesinol, secoisolariciresinol, matairesinol, lariciresinol, cyclolariciresinol, and pinoresinol, and of the enterolignans 7-hydroxyenterolactone, enterodiol, and enterolactone, were measured using a validated method.</p> <p>Results</p> <p>The baseline levels of enterolactone, enterodiol and the sum of lignans were higher in the control group, whereas at the end of the trial their levels were higher in the intervention group. The adjusted mean differences between the baseline and end of the intervention for enterolactone and the total lignan intake were 1.6 ng/ml (p = 0.018, 95% CI 1.1-2.3) and 1.4 ng/mg (p = 0.08, 95% CI 1.0-1.9) higher in the intervention group than in the controls. Further adjustment for dietary components did not change these associations.</p> <p>Conclusion</p> <p>The dietary intervention was successful in increasing the intake of lignan-rich food products, the fiber consumption and consequently the plasma levels of lignans in pregnant women.</p> <p>Trial registration</p> <p><b>ISRCTN21512277, <url>http://www.isrctn.org</url></b></p

Reproduction, Hysterectomy and Risk of Cardiovascular Disease

Background: Cardiovascular disease (CVD), the most common cause of death in most developed countries, have gender-specific characteristics. Protective effect of endogenous estrogen for CVD is established. In older ages, women have similar rates of CVD, and even a higher prevalence of hypertension than that of men. Although CVD is considered as a man s disease , CVD kills more women. Most of our knowledge about management guidelines for CVD in women arise from studies conducted mostly in men. The increasing number of women with CVD shows the substantial need for identification of those specific variables relevant to cardiovascular health in women. Whether pregnancy-related factors and hysterectomy would reveal some of these variables and risk for CVD, is still uncertain. Objective: To further elucidate the associations between reproduction, hysterectomy, and risk of CVD in women. Materials and methods: Data were obtained from Health 2000 study, a cross-sectional comprehensive survey carried out in 2000-1 in Finland, except for Study II. Study I comprised 746 Finnish women aged 45-74, in which associations of reproductive history (assessed by questionnaire) and measures of subclinical atherosclerosis (by ultrasonographic detection) were studied. In Study III, associations between pregnancy-related factors and isolated systolic hypertension (ISH) were assessed in 3,937 Finnish women aged 30-99. In Study IV, data of 2,514 Finnish women aged 30-99 were used to investigate associations between hysterectomy and CVD. A total of 4,090 Finnish women who delivered in the period 1954-1963 were followed up for an average of 44 years in Study II. Mortality data were obtained from the Finnish cause-of-death registry. Logistic, linear regression and Cox-proportional hazard models were used for analysis. Results: Women with a history of stillbirth tended to have higher IMT than other women. A history of stillbirth was associated with an increased age-adjusted risk of plaque [Odd ratio (OR): 3.43, 95% CI: 1.07-11.05] but in the fully-adjusted model it lost its statistical significance (OR:2.73, 95% CI: 0.55-13.55). Cardiovascular mortality was significantly higher among women with systolic hypertension in early or late pregnancy than in normotensive subjects. Younger age at first delivery predicted a higher risk of ISH (OR after adjustment for age, height, weight diastolic blood pressure (BP), fasting blood glucose, low-density lipoprotein and total cholesterol, education, smoking, and physical activity: 1.04, 95 % CI: 1.01-1.06). Age at first and last delivery was significantly associated with age, education and marital status; age at first delivery was also associated with toxemia in any pregnancy, weight and BMI. Hysterectomy was significantly associated with hypertension, angina pectoris, stroke, age, education, oral contraceptive use, postmenopausal hormone therapy, BMI, fasting blood glucose, and cholesterol. The fully-adjusted ORs for associations between CVD and hysterectomy were dramatically lower than the crude ORs and remained significant only for medication for hypertension. Conclusion: Hypertension in pregnancy and earlier age at first delivery may predict higher risk of CVD in later life. The adverse effect of child bearing and hysterectomy, as the most common non-obstetric surgery, on cardiovascular systems seems to be mediated by more adverse common known risk factors, rather than these factors per se. Pregnancy acts as an important screening opportunity for CVD. Further studies are needed to show whether risk of later CVD morbidity or mortality decreases with early intervention and precise control of common known risk factors of CVD in women who delivered in younger age or who had experienced pregnancy complication such as systolic hypertension.Background: Cardiovascular disease (CVD), the most common cause of death in most developed countries, have gender-specific characteristics. Protective effect of endogenous estrogen for CVD is established. In older ages, women have similar rates of CVD, and even a higher prevalence of hypertension than that of men. Although CVD is considered as a man s disease , CVD kills more women. Most of our knowledge about management guidelines for CVD in women arise from studies conducted mostly in men. The increasing number of women with CVD shows the substantial need for identification of those specific variables relevant to cardiovascular health in women. Whether pregnancy-related factors and hysterectomy would reveal some of these variables and risk for CVD, is still uncertain. Objective: To further elucidate the associations between reproduction, hysterectomy, and risk of CVD in women. Materials and methods: Data were obtained from Health 2000 study, a cross-sectional comprehensive survey carried out in 2000-1 in Finland, except for Study II. Study I comprised 746 Finnish women aged 45-74, in which associations of reproductive history (assessed by questionnaire) and measures of subclinical atherosclerosis (by ultrasonographic detection) were studied. In Study III, associations between pregnancy-related factors and isolated systolic hypertension (ISH) were assessed in 3,937 Finnish women aged 30-99. In Study IV, data of 2,514 Finnish women aged 30-99 were used to investigate associations between hysterectomy and CVD. A total of 4,090 Finnish women who delivered in the period 1954-1963 were followed up for an average of 44 years in Study II. Mortality data were obtained from the Finnish cause-of-death registry. Logistic, linear regression and Cox-proportional hazard models were used for analysis. Results: Women with a history of stillbirth tended to have higher IMT than other women. A history of stillbirth was associated with an increased age-adjusted risk of plaque [Odd ratio (OR): 3.43, 95% CI: 1.07-11.05] but in the fully-adjusted model it lost its statistical significance (OR:2.73, 95% CI: 0.55-13.55). Cardiovascular mortality was significantly higher among women with systolic hypertension in early or late pregnancy than in normotensive subjects. Younger age at first delivery predicted a higher risk of ISH (OR after adjustment for age, height, weight diastolic blood pressure (BP), fasting blood glucose, low-density lipoprotein and total cholesterol, education, smoking, and physical activity: 1.04, 95 % CI: 1.01-1.06). Age at first and last delivery was significantly associated with age, education and marital status; age at first delivery was also associated with toxemia in any pregnancy, weight and BMI. Hysterectomy was significantly associated with hypertension, angina pectoris, stroke, age, education, oral contraceptive use, postmenopausal hormone therapy, BMI, fasting blood glucose, and cholesterol. The fully-adjusted ORs for associations between CVD and hysterectomy were dramatically lower than the crude ORs and remained significant only for medication for hypertension. Conclusion: Hypertension in pregnancy and earlier age at first delivery may predict higher risk of CVD in later life. The adverse effect of child bearing and hysterectomy, as the most common non-obstetric surgery, on cardiovascular systems seems to be mediated by more adverse common known risk factors, rather than these factors per se. Pregnancy acts as an important screening opportunity for CVD. Further studies are needed to show whether risk of later CVD morbidity or mortality decreases with early intervention and precise control of common known risk factors of CVD in women who delivered in younger age or who had experienced pregnancy complication such as systolic hypertension

Reproduction, Hysterectomy and Risk of Cardiovascular Disease

Background: Cardiovascular disease (CVD), the most common cause of death in most developed countries, have gender-specific characteristics. Protective effect of endogenous estrogen for CVD is established. In older ages, women have similar rates of CVD, and even a higher prevalence of hypertension than that of men. Although CVD is considered as a man s disease , CVD kills more women. Most of our knowledge about management guidelines for CVD in women arise from studies conducted mostly in men. The increasing number of women with CVD shows the substantial need for identification of those specific variables relevant to cardiovascular health in women. Whether pregnancy-related factors and hysterectomy would reveal some of these variables and risk for CVD, is still uncertain. Objective: To further elucidate the associations between reproduction, hysterectomy, and risk of CVD in women. Materials and methods: Data were obtained from Health 2000 study, a cross-sectional comprehensive survey carried out in 2000-1 in Finland, except for Study II. Study I comprised 746 Finnish women aged 45-74, in which associations of reproductive history (assessed by questionnaire) and measures of subclinical atherosclerosis (by ultrasonographic detection) were studied. In Study III, associations between pregnancy-related factors and isolated systolic hypertension (ISH) were assessed in 3,937 Finnish women aged 30-99. In Study IV, data of 2,514 Finnish women aged 30-99 were used to investigate associations between hysterectomy and CVD. A total of 4,090 Finnish women who delivered in the period 1954-1963 were followed up for an average of 44 years in Study II. Mortality data were obtained from the Finnish cause-of-death registry. Logistic, linear regression and Cox-proportional hazard models were used for analysis. Results: Women with a history of stillbirth tended to have higher IMT than other women. A history of stillbirth was associated with an increased age-adjusted risk of plaque [Odd ratio (OR): 3.43, 95% CI: 1.07-11.05] but in the fully-adjusted model it lost its statistical significance (OR:2.73, 95% CI: 0.55-13.55). Cardiovascular mortality was significantly higher among women with systolic hypertension in early or late pregnancy than in normotensive subjects. Younger age at first delivery predicted a higher risk of ISH (OR after adjustment for age, height, weight diastolic blood pressure (BP), fasting blood glucose, low-density lipoprotein and total cholesterol, education, smoking, and physical activity: 1.04, 95 % CI: 1.01-1.06). Age at first and last delivery was significantly associated with age, education and marital status; age at first delivery was also associated with toxemia in any pregnancy, weight and BMI. Hysterectomy was significantly associated with hypertension, angina pectoris, stroke, age, education, oral contraceptive use, postmenopausal hormone therapy, BMI, fasting blood glucose, and cholesterol. The fully-adjusted ORs for associations between CVD and hysterectomy were dramatically lower than the crude ORs and remained significant only for medication for hypertension. Conclusion: Hypertension in pregnancy and earlier age at first delivery may predict higher risk of CVD in later life. The adverse effect of child bearing and hysterectomy, as the most common non-obstetric surgery, on cardiovascular systems seems to be mediated by more adverse common known risk factors, rather than these factors per se. Pregnancy acts as an important screening opportunity for CVD. Further studies are needed to show whether risk of later CVD morbidity or mortality decreases with early intervention and precise control of common known risk factors of CVD in women who delivered in younger age or who had experienced pregnancy complication such as systolic hypertension.Background: Cardiovascular disease (CVD), the most common cause of death in most developed countries, have gender-specific characteristics. Protective effect of endogenous estrogen for CVD is established. In older ages, women have similar rates of CVD, and even a higher prevalence of hypertension than that of men. Although CVD is considered as a man s disease , CVD kills more women. Most of our knowledge about management guidelines for CVD in women arise from studies conducted mostly in men. The increasing number of women with CVD shows the substantial need for identification of those specific variables relevant to cardiovascular health in women. Whether pregnancy-related factors and hysterectomy would reveal some of these variables and risk for CVD, is still uncertain. Objective: To further elucidate the associations between reproduction, hysterectomy, and risk of CVD in women. Materials and methods: Data were obtained from Health 2000 study, a cross-sectional comprehensive survey carried out in 2000-1 in Finland, except for Study II. Study I comprised 746 Finnish women aged 45-74, in which associations of reproductive history (assessed by questionnaire) and measures of subclinical atherosclerosis (by ultrasonographic detection) were studied. In Study III, associations between pregnancy-related factors and isolated systolic hypertension (ISH) were assessed in 3,937 Finnish women aged 30-99. In Study IV, data of 2,514 Finnish women aged 30-99 were used to investigate associations between hysterectomy and CVD. A total of 4,090 Finnish women who delivered in the period 1954-1963 were followed up for an average of 44 years in Study II. Mortality data were obtained from the Finnish cause-of-death registry. Logistic, linear regression and Cox-proportional hazard models were used for analysis. Results: Women with a history of stillbirth tended to have higher IMT than other women. A history of stillbirth was associated with an increased age-adjusted risk of plaque [Odd ratio (OR): 3.43, 95% CI: 1.07-11.05] but in the fully-adjusted model it lost its statistical significance (OR:2.73, 95% CI: 0.55-13.55). Cardiovascular mortality was significantly higher among women with systolic hypertension in early or late pregnancy than in normotensive subjects. Younger age at first delivery predicted a higher risk of ISH (OR after adjustment for age, height, weight diastolic blood pressure (BP), fasting blood glucose, low-density lipoprotein and total cholesterol, education, smoking, and physical activity: 1.04, 95 % CI: 1.01-1.06). Age at first and last delivery was significantly associated with age, education and marital status; age at first delivery was also associated with toxemia in any pregnancy, weight and BMI. Hysterectomy was significantly associated with hypertension, angina pectoris, stroke, age, education, oral contraceptive use, postmenopausal hormone therapy, BMI, fasting blood glucose, and cholesterol. The fully-adjusted ORs for associations between CVD and hysterectomy were dramatically lower than the crude ORs and remained significant only for medication for hypertension. Conclusion: Hypertension in pregnancy and earlier age at first delivery may predict higher risk of CVD in later life. The adverse effect of child bearing and hysterectomy, as the most common non-obstetric surgery, on cardiovascular systems seems to be mediated by more adverse common known risk factors, rather than these factors per se. Pregnancy acts as an important screening opportunity for CVD. Further studies are needed to show whether risk of later CVD morbidity or mortality decreases with early intervention and precise control of common known risk factors of CVD in women who delivered in younger age or who had experienced pregnancy complication such as systolic hypertension