Women who’ve had hysterectomies have more cardiovascular disease (CVD) risk factors — making them more prone to heart disease and stroke than women who have not had their uterus removed, researchers reported in Circulation: Journal of the American Heart Association.
Hysterectomy is the most common surgical procedure for U.S. women. An estimated one-third of U.S. women will undergo the procedure by age 65.
In a study of nearly 90,000 women, researchers confirmed that women who had undergone a hysterectomy had a 26 percent higher risk of a cardiovascular event compared to women who had not undergone hysterectomy. CVD events in this study were defined as having coronary death, heart attack, stroke or coronary revascularization procedures.
However, the women who had a hysterectomy also had more cardiovascular risk factors such as hypertension, diabetes and high blood pressure than the women who had not had a hysterectomy.
“We cannot rule out some small residual influence of the surgery itself on cardiovascular events,” said Barbara V. Howard, Ph.D., president of the MedStar Research Institute in Hyattsville, Md. “But it looks as if women with hysterectomies have more heart disease because women who get hysterectomies also have more risk factors.”
The study has a clear implication for physicians, Howard added. “When physicians take care of women who have had hysterectomies, they need to be more attuned to the fact that these women may be prone to heart attack.”
Howard and her colleagues are investigators for the Women’s Health Initiative (WHI) Observation Study, which is following 93,676 postmenopausal women (ages 50 to 79) to better understand the development and courses of chronic diseases in older women.
The researchers conducted this analysis after another WHI analysis on the effects of postmenopausal estrogen treatments on women found a higher rate of cardiovascular disease in women who’d had a hysterectomy.
“We wanted to see if women who had hysterectomies differed in some way from those who did not, and whether the hysterectomy itself had an influence on heart disease,” Howard said.
After eliminating study participants for whom they had inadequate hysterectomy and oophorectomy (ovary removal) information, the researchers analyzed data from 89,914 women. Forty-one percent of them had undergone a hysterectomy and about half had also had a bilateral oophorectomy (removal of both ovaries).
Among the study’s key findings:
Compared to whites in the study, black, American Indian and Hispanic women were more likely to have had a hysterectomy, while Asian/Pacific Islander women were less likely.
At trial entry, women who had undergone hysterectomy tended to be more obese; have larger waists; suffer more hypertension, diabetes, and higher cholesterol requiring medications; and they had higher white blood cell counts – a sign of inflammation. Women with hysterectomies also exercised less and consumed more saturated fat.
The women with hysterectomies had a greater history of heart disease.
After an average of 5.1 years of follow-up, the rate of fatal and nonfatal cardiovascular disease was significantly higher in the women with hysterectomies, whether or not they had an oophorectomy. Women who had just a hysterectomy had a 23 percent increased risk of cardiovascular problems; those who had a hysterectomy and oophorectomy had a 28 percent higher risk.
However, when researchers accounted for all cardiovascular risk factors, they discovered women who had undergone hysterectomies had a slight but statistically non-significant higher risk than women who had not had the surgery.
While the study was not designed to answer why women who have a hysterectomy have a higher rate of risk factors, researchers said the likely explanation is that women who had hysterectomies in this study tended to be of lower socioeconomic levels than the women without hysterectomy.
Co-authors are Lewis Kuller, M.D.; Robert Langer, M.D.; JoAnn E. Manson, M.D.; Catherine Allen, Ph.D.; Annlouise Assaf, Ph.D.; Barbara B. Cochrane, Ph.D., R.N.; Joseph C. Larson, M.S.; Norman Lasser, M.D.; Monique Rainford, M.D.; Linda Van Horn, Ph.D.; Marcia L. Stefanick, Ph.D.; and Maurizio Trevisan, M.D.
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