Hysterectomy and risk of cardiovascular disease: a population-based cohort study
Abstract
AIMS: Hysterectomy for benign indications is one of the commonest surgical procedures in women, but the association between the procedure and cardiovascular disease (CVD) is not fully understood. In this population-based cohort study, we studied the effects of hysterectomy, with or without oopherectomy, on the risk of later life CVD. METHODS AND RESULTS: Using nationwide healthcare registers, we identified all Swedish women having a hysterectomy on benign indications between 1973 and 2003 (n = 184,441), and non-hysterectomized controls (n = 640,043). Main outcome measure was the first hospitalization or death of incident CVD (coronary heart disease, stroke, or heart failure). Occurrence of CVD was determined by individual linkage to the Inpatient Register. In women below age 50 at study entry, hysterectomy was associated with a significantly increased risk of CVD during follow-up [hazard ratio (HR), 1.18, 95% confidence interval (CI), 1.13-1.23; HR, 2.22, 95% CI, 1.01-4.83; and HR, 1.25, 95% CI, 1.06-1.48; in women without oopherectomy, with oopherectomy before or at study entry, respectively, using women without hysterectomy or oopherectomy as reference]. In women aged 50 or above at study entry, there were no significant associations between hysterectomy and incident CVD. CONCLUSIONS: Hysterectomy in women aged 50 years or younger substantially increases the risk for CVD later in life and oopherectomy further adds to the risk of both coronary heart disease and stroke.
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Treatments for endometriosis, including hysterectomy or oophorectomy and analgesics, may increase the risk of coronary heart disease in women with endometriosis.
“In addition, the treatments of endometriosis, such as hysterectomy or oophorectomy (20-24) and analgesics (25) may confer increased risk of CHD to women with endometriosis.”
From Endometriosis and Risk of Coronary Heart Disease (2016) · cites this paper as [23]
The Results (p. 3) associate hysterectomy and oophorectomy with increased coronary heart disease risk in women under 50, supporting the surgical-treatment portion of the claim. The paper does not establish that risk specifically in women with endometriosis, and reports a different pattern in women aged 50 or older. Analgesics are attached to a separate citation in the citing sentence. (LLM, conf=0.86)
Experimental — accuracy not yet measuredSurgically induced menopause before natural menopause may increase coronary heart disease risk, and this elevated risk may be most evident at younger ages.
“The surgically-induced menopause prior to a natural menopause may increase risk of CHD among women, and this elevated risk may be most evident at a younger age (i.e., before all women reach natural menopause). (20-24)”
From Endometriosis and Risk of Coronary Heart Disease (2016) · cites this paper as [23]
A nationwide study from Sweden showed that hysterectomy without oophorectomy was associated with an increased risk of cardiovascular diseases in women age <50 but not in women age ≥50.
“A nationwide study from Sweden showed that hysterectomy without oophorectomy was associated with an increased risk of cardiovascular diseases in women age<50 but not in women age ≥50.(23, 24)”
From Endometriosis and Risk of Coronary Heart Disease (2016) · cites this paper as [23]
Loss of ovarian function and subsequent deficiency of endogenous estrogens may be the biologic mechanism for the association between bilateral oophorectomy and cardiovascular diseases, while simple hysterectomy can interfere with ovarian blood flow and may result in premature ovarian failure.
“Loss of ovarian function and subsequent deficiency of endogenous estrogens may be the biologic mechanism for association between bilateral oophorectomy and cardiovascular diseases, while simple hysterectomy can interfere with ovarian blood flow and may result in premature ovarian failure.(23)”
From Endometriosis and Risk of Coronary Heart Disease (2016) · cites this paper as [23]
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- Authors
- Ingelsson, E., Lundholm, C., Johansson, A. L. V., & Altman, D.
- Affiliations
- Karolinska Institutet (SE)
- Danderyds sjukhus (SE)
- Corresponding author
- Altman, D.
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2010-12-24
- Volume
- 32
- Issue
- 6
- Pages
- 745-750
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- OpenAlex
- W2118949079
- Semantic Scholar
- 5f1a80939f17c3c1044625194d9e31260af878bd
- Cited by
- 200
- References
- 24
- Citations by year
- 2026: 12 · 2025: 13 · 2024: 22 · 2023: 21 · 2022: 11 · 2021: 12 · 2020: 13 · 2019: 11 · 2018: 18 · 2017: 9 · 2016: 10 · 2015: 9 · 2014: 7 · 2013: 11 · 2012: 14
- FWCI
- 14.01
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Keywords
- hysterectomy, oophorectomy, cardiovascular disease, coronary artery disease, stroke, heart failure, benign hysterectomy, young women, postmenopausal women, surgical risk
- MeSH terms
- Adolescent, Adult, Cardiovascular Diseases, Coronary Disease, Female, Humans, Hysterectomy, Middle Aged, Ovariectomy, Risk Factors, Sweden, Cohort Studies, Incidence, Stroke, Young Adult
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