Hysterectomy and Risk of Cardiovascular Disease

A Population-Based Cohort Study

Erik Ingelsson; Cecilia Lundholm; Anna L.V. Johansson; Daniel Altman

Disclosures

Eur Heart J. 2011;32(6):745-750. 

In This Article

Abstract and Introduction

Abstract

Aims Hysterectomy for benign indications is one of the commonest surgical procedures in women, but the association between the procedure and cardiovascular disease (CVD) is not fully understood. In this population-based cohort study, we studied the effects of hysterectomy, with or without oopherectomy, on the risk of later life CVD.
Methods and results Using nationwide healthcare registers, we identified all Swedish women having a hysterectomy on benign indications between 1973 and 2003 (n = 184 441), and non-hysterectomized controls (n = 640 043). Main outcome measure was the first hospitalization or death of incident CVD (coronary heart disease, stroke, or heart failure). Occurrence of CVD was determined by individual linkage to the Inpatient Register. In women below age 50 at study entry, hysterectomy was associated with a significantly increased risk of CVD during follow-up [hazard ratio (HR), 1.18, 95% confidence interval (CI), 1.13–1.23; HR, 2.22, 95% CI, 1.01–4.83; and HR, 1.25, 95% CI, 1.06–1.48; in women without oopherectomy, with oopherectomy before or at study entry, respectively, using women without hysterectomy or oopherectomy as reference]. In women aged 50 or above at study entry, there were no significant associations between hysterectomy and incident CVD.
Conclusions Hysterectomy in women aged 50 years or younger substantially increases the risk for CVD later in life and oopherectomy further adds to the risk of both coronary heart disease and stroke.

Introduction

Hysterectomy has traditionally been considered the method of choice for treating a variety of benign gynaecological disorders due to the low perioperative morbidity and definite cure of these diseases.[1] Incidence rates of hysterectomy in the USA and in western European countries have remained relatively stable,[2–6] despite recent years introduction of minimally invasive treatment options for conditions, such as menorrhagia and leiomyoma.[7]

Studies have shown that hysterectomy might be associated with an increased risk for cardiovascular disease (CVD),[8–11] but the epidemiological evidence is inconclusive. Previous studies have typically been too small to study associations of hysterectomy with separate types of CVD, such as coronary heart disease and stroke, with adequate statistical strength. Furthermore, temporal relations, such as time elapsed from hysterectomy and oopherectomy (concomitant with the hysterectomy or at a later time point), have been indicated to be of importance for CVD risks but are poorly understood.[10]

Bilateral salpingo-oopherectomy is the only unambiguous preventive measure for ovarian cancer and results in an abrupt transition to menopause in premenopausal patients. Considering that the majority of hysterectomies is performed in perimenopausal women on relative indications,[5,6] increased knowledge about the long-term effects of hysterectomy and/or oopherectomy is critical. Even a moderate risk increase in future disease would be important, as the attributed risk still could be large since hysterectomy is such a common surgical procedure. This is particularly important in the case of CVD, the major cause of death in women globally.[12] The aim of this nationwide, population-based cohort study using prospectively recorded data from the Swedish national health registers was to assess the risk of CVD after hysterectomy for benign indications, with or without oopherectomy, throughout the lifespan.

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