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Cited by 248Menopause: Health Impacts and TreatmentsUterine Myomas and TreatmentsReproductive Health and Contraception

Risk of Cardiovascular Disease by Hysterectomy Status, With and Without Oophorectomy: The Women’s Health Initiative Observational Study

Howard, Barbara V., Kuller, Lewis, Langer, Robert, Manson, JoAnn E., Allen, Catherine, Assaf, Annlouise, Cochrane, Barbara B., Larson, Joseph C. +5 more·2005·Circulation
DOI 10.1161/01.cir.0000159344.21672.fd
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Abstract

Background— Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in women and may vary by hysterectomy (or oophorectomy) status. This study compared CVD risk factors and rates between postmenopausal women who had and had not undergone hysterectomy, with or without oophorectomy. Methods and Results— This analysis was conducted on 89 914 women in the Women’s Health Initiative (WHI) Observational Study. Participants reported demographic characteristics, medical history, dietary habits, physical activity, medications, and previous hysterectomy (with or without oophorectomy). Baseline weight, height, waist circumference, and blood pressure were measured. CVD events were ascertained during 5.1 years of mean follow-up and adjudicated with standard criteria. Black, Hispanic, and American Indian women had higher rates of hysterectomy than white women (52.9%, 44.6%, and 49.2% versus 40.0%, respectively), and Asian/Pacific Islander women had lower rates (33.8%). Women with a hysterectomy (regardless of oophorectomy status) had an adverse risk profile at baseline compared with women with no hysterectomy, including a higher proportion of hypertension, diabetes, high cholesterol, obesity, and lower education, income, and physical activity (all P <0.01). Total mortality and fatal and nonfatal CVD were higher among women with a hysterectomy. Hysterectomy (regardless of oophorectomy status) was a significant predictor of CVD (HR: 1.26, P <0.001). After adjustment for demographic variables and CVD risk factors, the effect was reduced and nonsignificant. Conclusions— Women with a hysterectomy had a worse risk profile and higher prevalence and incidence of CVD in this cohort. Multivariate models suggest that hysterectomy is not the major determinant of this outcome; rather, CVD risk may be due to the more adverse initial risk profile of women who had undergone hysterectomy.

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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 [24]

    The Results (page unavailable) report higher unadjusted rates of cardiovascular disease among women with a hysterectomy, with or without oophorectomy. But the study did not examine women with endometriosis as a group, and its hysterectomy associations with coronary heart disease outcomes were not statistically significant. This citation supports a possible cardiovascular association, not the specific claim of increased CHD risk in women with endometriosis; the separate analgesics citation is outside this verdict. (LLM, conf=0.84)

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  • Surgically 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 [24]

    The paper says that surgery well before natural menopause may affect cardiovascular function, and its Results report higher overall cardiovascular disease rates among women with a history of hysterectomy. It does not show that coronary heart disease risk is greatest at younger ages: the cohort was postmenopausal and aged 50–79, and the Results report no significant association for the specified coronary outcomes (MI or coronary death). Page numbers are unavailable in our copy. (LLM, conf=0.84)

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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.

    “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 [24]

    The Discussion (p. 1468) reports that hysterectomy without oophorectomy was associated with higher CVD risk in unadjusted analysis, but that the association was mostly no longer significant after adjustment for risk factors. This paper analyzes a US Women's Health Initiative cohort, not a nationwide Swedish study, and it does not report the claimed difference between women under and over 50. (LLM, conf=0.87)

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Research works printed but not linked: 2

  1. [3]3. Lepine LA, Hillis SD, Marchbanks PA, Koonin LM, Morrow B, Kieke BA, Wilcox LS. Hysterectomy surveillance: United States, 1980 -1993. MMWR CDC Surveill Summ. 1997;46:1-15.
  2. [19]19. Kenny SJ, Aubert RE, Geiss LS. Prevalence and incidence of non-insulin- dependent diabetes. In: National Diabetes Data Group, ed. Diabetes in America. Bethesda, Md: NIDDKD; 1995:47-68. NIH publication No. 95-1468.

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Authors
Howard, B. V., Kuller, L., Langer, R., Manson, J. E., Allen, C., Assaf, A., Cochrane, B. B., Larson, J. C., Lasser, N., Rainford, M., Van Horn, L., Stefanick, M. L., & Trevisan, M.
Affiliations
  • Brigham and Women's Hospital (US)
  • Northwestern University (US)
  • From the MedStar Research Institute (B.V.H., M.R.), Washington, DC; University of Pittsburgh (L.K.), Pittsburgh, Pa; UCSD School of Medicine (R.L.), La Jolla, Calif; Brigham and Women’s Hospital (J.E.M.), Harvard Medical School, Boston, Mass; University of Wisconsin (C.A.), Madison, Wis; The Memorial Hospital of Rhode Island (A.A.), Pawtucket, RI; Fred Hutchinson Cancer Research Center (B.B.C.), Seattle, Wash; University of Medicine and Dentistry of New Jersey (N.L.), Newark, NJ; Northwestern...
ORCID
Venue
Circulation
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2005-03-29
Volume
111
Issue
12
Pages
1462-1470
ISSN
  • 0009-7322 (ISSN-L)
  • 1524-4539
DOI
10.1161/01.cir.0000159344.21672.fd
OpenAlex
W2144111174
Semantic Scholar
80d41ebfdaee5967d9a3267ca18731fa5a2aa52b
Cited by
248
References
24
Citations by year
2026: 9 · 2025: 10 · 2024: 14 · 2023: 15 · 2022: 7 · 2021: 10 · 2020: 16 · 2019: 12 · 2018: 12 · 2017: 8 · 2016: 9 · 2015: 8 · 2014: 9 · 2013: 16 · 2012: 15
FWCI
8.07
Type
journal article
Language
en
Open access
closed
Locations
  • Circulation (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • U.S. Department of Health and Human Services
  • Brown University
  • University of Nevada, Reno
  • National Heart, Lung, and Blood Institute
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
  • Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
Keywords
hysterectomy, oophorectomy, cardiovascular disease, postmenopausal women, cardiovascular risk factors, cardiovascular mortality, racial and ethnic disparities, Women's Health Initiative Observational Study, hypertension, diabetes mellitus, obesity
MeSH terms
Adult, Aged, Cardiovascular Diseases, Ethnicity, Female, Humans, Hysterectomy, Middle Aged, Ovariectomy, Risk Factors, Incidence, Multivariate Analysis, Age Distribution, Postmenopause

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