Cardiovascular risk rises with hysterectomy in women under 50

Hysterectomy, with or without oophorectomy, increases the chances of developing cardiovascular disease in women younger than 50 years of age, a study from the Karolinska Institutet, Stockholm, Sweden, indicates.

Researchers compared 184,441 Swedish women, identified from nationwide health care registers, who had a hysterectomy for benign indications between 1973 and 2003, with controls who didn’t undergo hysterectomy. The primary outcome measure was first hospitalization or death caused by incident cardiovascular disease (ie, coronary heart disease, stroke, or heart failure), as determined by linking individual patients to the Swedish Inpatient Register.

Women younger than 50 years had a significantly higher risk of both coronary heart disease and stroke after hysterectomy than controls. The increase was independent of socioeconomic status. Women older than 50 years showed no significant association between hysterectomy and cardiovascular disease.

The authors conclude that hysterectomy in women 50 years or younger “substantially increases” the risk of cardiovascular disease in later life and that oophorectomy adds to the risk of both coronary heart disease and stroke.

“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,” notes senior author Daniel Altman, MD. Removal of the uterus may affect the blood supply to the ovaries and push women into early menopause, he speculates.

Altman notes that the study results have global or important implications for women’s health in light of the trend toward more hysterectomies at earlier ages to treat a variety of gynecologic conditions. Cardiovascular risk should be considered before recommending hysterectomy, he says.

The study was published online December 24 in the European Heart Journal.