Hysterectomy Linked With Large Artery Stiffening

Estrogen-deficient women who have had a hysterectomy with or without ovarian preservation are more likely to have arterial stiffness than estrogen-deficient women who have not had a hysterectomy, according to results of a new study conducted at the University of Colorado School of Medicine in Denver.¹ These findings are significant because hysterectomies are among the most common surgical procedures performed on women, second only to cesarean sections.

Of 103 postmenopausal women who were not taking any hormone replacement therapy, 24 had a hysterectomy with ovarian preservation, 21 had a hysterectomy with bilateral oophorectomy, and 58 had no hysterectomy or oophorectomy.¹ None of the women had a history of cardiovascular disease or traditional risk factors for cardiovascular disease, such as obesity, high blood pressure, high cholesterol levels, or diabetes. Arterial stiffness-measured by ultrasonography of the carotid artery-was then compared between study groups. The clinical significance of arterial stiffening is that as the carotid artery becomes less elastic, pressure begins to increase even with normal blood flow, potentially causing high blood pressure, enlargement of the heart, and even heart failure.²

According to study findings, women who had had a hysterectomy with or without preservation of the ovaries had stiffer carotid arteries than women who had no history of hysterectomy or oophorectomy.¹ Even after adjustment for age, duration of menopause, duration of previous hormone replacement therapy for menopause, parity, waist-to-hip ratio, systolic blood pressure, and sex hormone-binding globulin, hysterectomy persisted as a significant predictor of arterial stiffness.

The mechanism by which hysterectomy would result in arterial stiffening is not completely understood. One study author suggests that after removal of the uterus and ovaries, women lose the protective effect that estrogen has against cardiovascular disease.

The lead author of the study, Kerrie Moreau, PhD, gave perspective to the findings²: “[K]nowing that having a hysterectomy may lead to a decline in cardiovascular health can help women take steps to ensure better cardiovascular health, like getting enough exercise and/or eating well after undergoing a hysterectomy.”

Pertinent Points:
- Large artery stiffening may be a significant mechanism by which hysterectomy increases the risk of cardiovascular disease in postmenopausal women.
- These findings underscore the importance for women who have had a hysterectomy to be extra cautious about their cardiovascular health.

References:

1. Gavin KM, Jankowski C, Kohrt WM, et al. Hysterectomy is associated with large artery stiffening in estrogen-deficient postmenopausal women. Menopause. June 11, 2012. [Epub ahead of print.]

2. Hysterectomy may lead to arterial stiffening in postmenopausal women. Available at: http://www.eurekalert.org/pub_releases/2012-06/uocd-hml061312.php. Accessed June 15, 2012.