Women under 50 undergoing hysterectomy, with or without oophorectomy, are at an increased risk of heart disease, a new Swedish study suggests [1].

Senior author Dr Daniel Altman (Karolinska Institute, Stockholm, Sweden) commented to heartwire : “This is one of the largest studies of hysterectomy/oophorectomy and cardiovascular disease and probably has the longest duration of follow-up–over three decades–so it is a unique investigation. Before, it was thought that only women undergoing oophorectomy had an increased cardiovascular risk, but our results show that hysterectomy alone is also associated with a raised risk of heart disease. As hysterectomy is a very common procedure and cardiovascular disease is the number-one killer of women, these results have enormous public-health implications.”

The study, led by Dr Erik Ingelsson (Karolinska Institute), was published online December 24, 2010 in the European Heart Journal.

The authors used nationwide healthcare registers to identify all Swedish women having a hysterectomy for benign indications between 1973 and 2003. They found 184 441 such patients who were compared with control women who had not undergone hysterectomy. The main outcome measure was the first hospitalization or death due to incident cardiovascular disease (coronary heart disease, stroke, or heart failure), which was determined by individual linkage to the Swedish Inpatient Register.

Results showed that in women below age 50 at study entry, hysterectomy was associated with a significantly increased risk of cardiovascular disease during follow-up. This risk increase was consistent for incidence in coronary heart disease as well as stroke, and it was evident also after the researchers took socioeconomic status into account.

In women aged 50 or above at study entry, there were no significant associations between hysterectomy and incident cardiovascular disease.

He explained that it is believed to be the removal of the ovaries that causes the increase in cardiovascular disease in premenopausal women. That heart disease was also raised in women undergoing hysterectomy alone could be explained by the removal of the uterus, affecting the blood supply to the ovaries, so women may enter the menopause earlier, he suggested.

Altman says that on the basis of these results, cardiovascular risk should be considered before recommending hysterectomy. He points out that there is now a trend for more women to be undergoing hysterectomies at earlier ages, as it is generally a very safe procedure and cures many gynecological problems and there is a high level of postoperative satisfaction. He estimates that about one in five women undergo hysterectomies during their lifetime in the UK and about one in three in the US.

Altman admits his study does have some limitations–it is observational and recorded only cardiovascular events necessitating a hospital stay. But he points out that this probably underestimated the risk. “This is not a definitive study, but it certainly strengthens the case that hysterectomy increases cardiovascular risk. And definitive evidence on this link will probably never be obtained, as it will not be possible to do a randomized study with sufficient participants. But I would urge gynecologists to consider this risk and discuss it with women who may be candidates for hysterectomy, especially those who already have an increased risk. If a woman already has cardiovascular disease or high blood pressure, that should ring a warning bell.”

Results Different From WHI Study

At first glance, these results appear to be opposite to those of an analysis from the Women’s Health Initiative (WHI), which found no association of hysterectomy and cardiovascular disease.

Asked about this, Altman said that actually the main outcomes from the two studies were not that different, but the Swedish study stratified outcomes by age 50 (reflecting the mean age of menopause in Sweden), which the WHI study did not. He also noted that the overall risk estimate for the association between hysterectomy and cardiovascular disease was quite similar, although in the WHI study after adjustment for demographic variables and baseline risk factors, the effect was reduced and nonsignificant. He suggested this could be due to fewer cases in the WHI study, which could be related to a shorter follow-up. “Alternatively, we did not have access to the same covariates and thus were unable to adjust for some unknown relevant factor that confounded the association.”

He added that the WHI study relied on volunteers, whereas the Swedish study looked at the general population, which may have implications for the outcomes in several ways.

Sue Hughes Click here for original article.

J. Kyle Mathews, MD

Plano OBGYN Associates

Plano Urogynecology Associates

“Please note, this study has not been peer reviewed as of this posting and should be considered for discussion purposes only at this time.” J. Kyle Mathews, MD

Tags: Cardiovascular Risk, coronary, dallas, disease, Dr. Mathews, European Heart Journal, frisco, heart disease, Hysterectomy, kyle mathews, ovaries, plano, Swedish Inpatient Register, WHI, without, women | Category: Gynecology, Hysterectomies, News & Education |