Increased risk of heart disease after hysterectomy

In an effort to reduce the associated increased risk of heart disease after hysterectomy, more surgeons are opting to leave a woman's ovaries intact. However, a study shows that women (especially those aged younger than 35 years) having a hysterectomy with ovarian conservation are still at increased risk. 

Hysterectomies are often the recommended treatment for women suffering from heavy menstrual bleeding and other gynecologic problems. More than 400,000 hysterectomies are performed each year in the United States, most for benign disease. Although multiple studies have previously documented an increased risk of cardiovascular disease and other chronic problems from hysterectomies involving the removal of both ovaries, few studies have focused on the health risks after the removal of only the uterus.  

"Cardiovascular and metabolic morbidity after hysterectomy with ovarian conservation: a cohort study" details results from the nearly 22-year follow-up of more than 2,000 women who underwent hysterectomy with ovarian conversation for benign indications. The study found that these women experienced increased risks of hyperlipidemia (a high concentration of fats in the blood), hypertension, obesity, cardiac arrhythmias, and coronary artery disease. Women who underwent hysterectomy aged 35 years or younger had a 4.6-fold increased risk of congestive heart failure and a 2.5-fold increased risk of coronary artery disease.

 Abstract

Objective:

The aim of the study was to determine the long-term risk of cardiovascular disease and metabolic conditions in women undergoing hysterectomy with bilateral ovarian conservation compared with age-matched referent women.

Methods:

Using the Rochester Epidemiology Project records-linkage system, we identified 2,094 women who underwent hysterectomy with ovarian conservation for benign indications between 1980 and 2002 in Olmsted County, Minnesota. Each woman was age-matched (±1 y) to a referent woman residing in the same county who had not undergone prior hysterectomy or any oophorectomy. These two cohorts were followed historically to identify de novo cardiovascular or metabolic diagnoses. We estimated hazard ratios (HRs) and 95% CIs using Cox proportional hazards models adjusted for 20 preexisting chronic conditions and other potential confounders. We also calculated absolute risk increases and reductions from Kaplan-Meier estimates.

Results:

Over a median follow-up of 21.9 years, women who underwent hysterectomy experienced increased risks of de novo hyperlipidemia (HR 1.14; 95% CI, 1.05-1.25), hypertension (HR 1.13; 95% CI, 1.03-1.25), obesity (HR 1.18; 95% CI, 1.04-1.35), cardiac arrhythmias (HR 1.17; 95% CI, 1.05-1.32), and coronary artery disease (HR 1.33; 95% CI, 1.12-1.58). Women who underwent hysterectomy at age ≤35 years had a 4.6-fold increased risk of congestive heart failure and a 2.5-fold increased risk of coronary artery disease.

Conclusions:

Even with ovarian conservation, hysterectomy is associated with an increased long-term risk of cardiovascular and metabolic conditions, especially in women who undergo hysterectomy at age ≤35 years. If these associations are causal, alternatives to hysterectomy should be considered to treat benign gynecologic conditions.

Reference

Laughlin-Tommaso SK, Khan Z, Weaver AL, Smith CY, Rocca WA, Stewart EA. Cardiovascular and metabolic morbidity after hysterectomy with ovarian conservation: a cohort study. Menopause 2017 Dec 28. doi: 10.1097/GME.0000000000001043. [Epub ahead of print]

Content updated January 2018