Hysterectomy with and without oophorectomy, tubal ligation, and risk of cardiovascular disease in the Nurses' Health Study II
12 June 2023
Summary
Hysterectomy, oophorectomy, and tubal ligation are common surgical procedures; however, reports linking cardiovascular disease (CVD) risk after these surgeries have basically focused on oophorectomy with limited research on hysterectomy or tubal ligation. Recently, Farland et al. [1] reported on data of participants of the Nurses' Health Study II (n = 116,429) who were followed from 1989 to 2017. Self-reported gynecologic surgery was categorized as follows: no surgery, hysterectomy alone, hysterectomy with unilateral oophorectomy, and hysterectomy with bilateral oophorectomy; the authors separately investigated tubal ligation alone. The primary outcome was CVD based on medical-record confirmed fatal and non-fatal myocardial infarction, fatal coronary heart disease, or fatal and nonfatal stroke. Secondary outcome expanded CVD to include coronary revascularization (coronary artery bypass graft surgery, angioplasty, stent placement). The authors used Cox proportional hazard models to calculate hazard ratios (HR) and 95% confidence intervals (CIs), a priori adjusted for confounding factors. Differences by age at surgery (≤50, >50) and menopausal hormone therapy usage was analyzed. Average age of participants at baseline was 34 years. During 2,899,787 person-years, the investigators observed 1,864 CVD cases. Hysterectomy in combination with any oophorectomy (unilateral or bilateral) was associated with a greater risk of CVD in multivariable-adjusted models. Hysterectomy alone, hysterectomy with oophorectomy (unilateral and bilateral), and tubal ligation were also associated with an increased risk of combined CVD and coronary revascularization (HR 1.19; HR 1.29; HR 1.22, and HR 1.16, respectively). The association between hysterectomy/oophorectomy and the risk of CVD and coronary revascularization varied by age when surgery was performed, with the strongest association observed if surgery was before age 50. The authors finally conclude that hysterectomy, alone or in combination with oophorectomy (any type), as well as tubal ligation, seems to be associated with a higher risk of CVD and coronary revascularization; indicating that these findings extend previous research finding that oophorectomy is associated with CVD.