A new study showed that hysterectomy alone, hysterectomy with oophorectomy, and tubal ligation were associated with an increased risk of cardiovascular disease (CVD). The findings and their implications are published in the peer-reviewed Journal of Women’s Health .
Summary
Background :
Hysterectomy, oophorectomy, and tubal ligation are common surgical procedures. The literature on the risk of cardiovascular disease (CVD) after these surgeries has focused on oophorectomy with limited research on hysterectomy or tubal ligation.
Materials and methods:
Participants in the Nurses’ Health Study II (n = 116,429) were followed from 1989 to 2017. Self-reported gynecologic surgery was classified as follows: no surgery, hysterectomy alone, hysterectomy with unilateral oophorectomy, and hysterectomy with bilateral oophorectomy. Tubal ligation alone was investigated separately.
The primary outcome was CVD based on medical record-confirmed fatal and non-fatal myocardial infarction, fatal coronary heart disease, or fatal and non-fatal stroke.
Our secondary outcome expanded CVD to include coronary revascularization (coronary artery bypass graft surgery, angioplasty, stenting). Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) and adjusted a priori for confounders. We investigated differences by age at surgery (≤50, >50) and use of hormonal therapy at menopause.
Results:
At the beginning of the study, participants were on average 34 years old. Over 2,899,787 person-years, we observed 1,864 CVD cases. Hysterectomy in combination with any oophorectomy was associated with an increased risk of CVD in multivariable-adjusted models (HR hysterectomy with unilateral oophorectomy: 1.40 [95% CI: 1.08–1.82]; HR hysterectomy with bilateral oophorectomy : 1.27 [1.07–1.51]).
Hysterectomy alone, hysterectomy with oophorectomy, and tubal ligation were also associated with an increased risk of combined CVD and coronary revascularization (HR hysterectomy alone: 1.19 [95% CI: 1.02–1.39]; HR hysterectomy with unilateral oophorectomy: 1.29 [1.01–1.64]; hysterectomy HR with bilateral oophorectomy: 1.22 [1.04-1.43]; tubal ligation HR: 1.16 [1.06-1 ,28]). The association between hysterectomy/oophorectomy and CVD and risk of coronary revascularization varied by age at gynecologic surgery, with the strongest association among women who underwent surgery before age 50 years.
Discussion:
Our findings suggest that hysterectomy, alone or in combination with oophorectomy, as well as tubal ligation, may be associated with an increased risk of CVD and coronary revascularization . These findings extend previous research findings that oophorectomy is associated with CVD.
Comments
Stacey Missmer, ScD, of the Harvard TH Chan School of Public Health and coauthors examined the association between no surgery, hysterectomy alone, hysterectomy with oophorectomy, or tubal ligation and CVD risk among Health Study participants. of Nurses II. CVD was based on confirmed fatal and nonfatal myocardial infarction, fatal coronary heart disease, or fatal and nonfatal stroke.
The researchers reported that the association between hysterectomy/oophorectomy and CVD risk varied by age at gynecologic surgery, with the strongest association among women who had surgery before age 50 .
"Physicians caring for women who have had gynecologic surgery, especially if it was performed before age 50, should be aware of women’s increased risk of cardiovascular disease and take appropriate preventive measures," says Susan G, editor-in-chief of the Journal of Women’s Health. Kornstein, MD, Executive Director, Institute for Women’s Health, Virginia Commonwealth University, Richmond, VA.
Final message In summary, we found that women who underwent ovarian-sparing hysterectomy, hysterectomy with oophorectomy, or tubal ligation had a higher risk of CVD and coronary revascularization than women who did not undergo these respective surgeries. This research builds on previous research suggesting that gynecologic surgery may influence CVD risk. Importantly, many of these gynecological interventions serve an important purpose in the treatment of a medical condition and may have other downstream effects that are beneficial to the patient’s overall health. Future research should further investigate mechanisms and protective factors to improve patient counseling. Clinicians should incorporate a discussion of CVD risk when counseling patients about the use of gynecologic surgery as a treatment for benign indications and tubal ligation as a method of contraception. |
