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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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“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]
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“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]
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“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]
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“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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“Additionally, some studies also investigated the association between hysterectomy and CVD with most of them concluding that hysterectomy significantly increases the risk of CVD 4,38–40 .”
Desai, S., Singh, R. J., Govil, D., Nambiar, D., Shukla, A., Sinha, H. H., Ved, R. R., Bhatla, N., & Mishra, G. D. (2023) · Figshare · doi:10.6084/m9.figshare.22600684
Li, Y., Zhao, D., Wang, M., Sun, J.-Y., Liu, J., Qi, Y., Hao, Y.-C., Deng, Q.-J., Liu, J., Liu, J., et al. (2021) · Figshare · doi:10.6084/m9.figshare.14100526
Bi, Y., Ma, Y., Zhang, J., Wang, S., Zhang, Q., Gao, Y., Hu, R., Lyu, N., Wang, H., Wang, B., et al. (2025) · BMC Medicine · doi:10.1186/s12916-025-04595-w
“…that women who underwent hysterectomy had a significantly higher risk of developing obesity [57], diabetes [15], hypertension [57, 76], hyperlipidemia [57, 77, 78], MAFLD [79, 80], metabolic syndrome [11], and cardiovascular disease [5, 8, 57] later on, compared to women without hysterectomy.”
Associations between hysterectomy history and depressive symptoms among women in the United States
Joseph, V. A., Robinson, W. R., Ananth, C. V., & Keyes, K. M. (2026) · AJE Advances Research in Epidemiology · doi:10.1093/ajeadv/uuaf024
Cardiovascular outcomes after hysterectomy: a systematic review and meta-analysis
Attachaipanich, T., Kaewboot, K., & Attachaipanich, S. (2026) · Baylor University Medical Center Proceedings · doi:10.1080/08998280.2026.2633069 · Cited by 1
“16,21,23,26,30,31,37 Hysterectomy at a premenopausal age was associated with a higher risk of CAD compared to no hysterectomy (pooled HR 1.14; 95% CI 1.10– 1.17, P < 0.01) (Supplemental Figure 27) .”
InfluentialGhosh, R., Syamala, T. S., & Mozumdar, A. (2026) · Discover Public Health · doi:10.1186/s12982-026-02107-6
“Beyond infertility, hysterectomy is associated with elevated risks of cardiovascular disease, cancers, additional surgeries, early ovarian failure, premature menopause, and depression [5, 13, 36, 38].”
Correlates of hysterectomy in low- and middle-income countries: a systematic review
Varghese, J. S., Desai, S., Debnath, S., Paul, S. B., & Mishra, G. D. (2026) · Journal of Global Health · doi:10.7189/jogh.16.04172
“These patterns are concerning because premenopausal hysterectomy is associated with an increased risk of osteoporosis, stroke, cardio-vascular disease, and frailty, potentially leading to women approaching older ages with a burden of chronic health conditions [ 17 – 20 ].”
Endometriosis and cardiovascular disease risk: a meta-analysis of cohort studies
Wang, L., Lu, Y., Pan, H., Li, X., & Luo, L. (2026) · Annals of Medicine · doi:10.1080/07853890.2025.2534083
“Mu et al. [20] highlighted that BSO before age 50 exacerbates CVD morbidity, likely due to abrupt estrogen depletion, whereas hysterectomy without ovarian removal increases risk only in younger women [31,32].”
Association Between Endometriosis and Cardiovascular Disease: Insights From the UK Biobank
Meijs, C., Grünberger, B., Peters, S. A. E., van der Schouw, Y. T., Onland‐Moret, N. C., Makawa, S., Seekircher, L., Zippl, A. L., Seeber, B., Fritz, J., et al. (2026) · Journal of the American Heart Association · doi:10.1161/jaha.125.048454
“41,42 45 Conversely, increased CVD risk has also been observed in women who had a hysterectomy with ovarian conservation, 16,38,39,41 challenging the decline in estrogen levels hypothesis.”
Hereditary Carcinoma of the Ovary, Fallopian Tubes, and Peritoneum
Porcayo, M. A. T. (2026) · Springer eBooks · doi:10.1007/978-3-032-13454-7_35
de Cortina, S. H., Karanam, R., Pramathesh, R., Begum, F., Jaykrishna, P., Srinivas, V., Hariprasad, R., Madhivanan, P., Adsul, P., & Somaiya, D. (2026) · Frontiers in Global Women s Health · doi:10.3389/fgwh.2026.1870806
“…women, hysterectomy with or without oophorectomy has been linked to increased risk for neurologic disease including stroke and dementia, cardiovascular disease such as hypertension, diabetes, obesity, osteoporosis, premature menopause, sexual dysfunction, and mood dysfunction (1, 2, 30 – 38).”
All‐cause mortality after self‐reported vs. hospital‐reported gynecological surgery: The HUNT study
Rosland, T. E., Johansen, N., Liavaag, A. H., Åsvold, B. O., Pripp, A. H., & Michelsen, T. M. (2026) · Acta Obstetricia Et Gynecologica Scandinavica · doi:10.1111/aogs.70354
Age at Iatrogenic Menopause and Cardiovascular Morbidity and Mortality
Armeni, E., Erkan, İ. B. Ö., & Kempegowda, P. (2026) · JAMA Network Open · doi:10.1001/jamanetworkopen.2026.37545
Association between tubal ligation and hysterectomy: Findings from a prospective cohort study
Varghese, J. S., Wilson, L. F., Desai, S., Debnath, S., Paul, S. B., & Mishra, G. D. (2026) · Maturitas · doi:10.1016/j.maturitas.2026.109149
Hachem, S., Vaduva, P., Laouali, N., Gelot, A., Briand, M., Eon, S., Kvaskoff, M., & Bonnet, F. (2026) · Maturitas · doi:10.1016/j.maturitas.2026.109160
Cardiovascular disease among diabetic women with bilateral oophorectomy.
Appiah, D. (2013) · ThinkIR: The University of Louisville's Institutional Repository (University of Louisville) · doi:10.18297/etd/43
“arbitrary age of 45 years) and those not receiving hormone therapy (51-54).”
BackgroundHormonale Status En Cardiovasculair Risico
Schouw, I. R. Y. V. D., Maas, A. H. E. M., & de Kleijn, M. J. J. (2011) · Bohn Stafleu van Loghum eBooks · doi:10.1007/978-90-313-8782-3_10
Metadata
- 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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