Hysterectomy and risk of cardiovascular disease: a population-based cohort study

• Published in: European heart journal 2011-03, Vol.32 (6), p.745-750
• Main Authors: INGELSSON, Erik, LUNDHOLM, Cecilia, JOHANSSON, Anna L. V, ALTMAN, Daniel
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - etiology; Cohort Studies; Coronary Disease - epidemiology; Coronary Disease - etiology; Coronary heart disease; Female; Heart; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Humans; Hysterectomy - adverse effects; Hysterectomy - statistics & numerical data; Incidence; Medical sciences; Medicin och hälsovetenskap; Middle Aged; Neurology; Ovariectomy - adverse effects; Ovariectomy - statistics & numerical data; Risk Factors; Stroke - epidemiology; Stroke - etiology; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the genital tract and mammary gland; Sweden - epidemiology; Vascular diseases and vascular malformations of the nervous system; Young Adult
• ISSN: 0195-668X; 1522-9645; 1522-9645
• DOI: 10.1093/eurheartj/ehq477

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. 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. 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.