Impact of hysterectomy on cardiovascular disease and different subtypes: a meta-analysis

To explore the association between hysterectomy and cardiovascular disease (CVD).

Observational studies from eight databases and reference lists of relevant studies were systematically searched up to January 2021. Pooled relative risks (RRs) and 95% CIs were calculated by the random-effects model. Subgroup analyses and meta-regressions were performed to explore potential sources of heterogeneity. Small-study effects were estimated by Egger's test and funnel plot.

Seventeen studies from 14 articles were included in our meta-analysis. Hysterectomy was positively related to CVD (1.16; 95% CI 1.03-1.30; sample size: 1,233,495). For the subtype, ischemic heart disease, the pooled RR (95% CI) for hysterectomy versus non-hysterectomy was 1.20 (95% CI 1.08-1.35; sample size: 1,210,504), and the pooled HR (95% CI) was 1.15 (95% CI 1.03-1.29; sample size: 1,181,924). In the association between ischemic heart disease and hysterectomy with ovarian preservation (1.33; 95% CI 1.05-1.68; sample size: 29,058) or hysterectomy with oophorectomy (1.31; 95% CI 1.02-1.67; sample size: 23,257), significant positive associations were observed. A significant association was also found with having hysterectomy before 50 years (1.19; 95% CI 1.01-1.41; sample size: 515,297), but not with after 50 years (1.16; 95% CI 0.87-1.54; sample size: 398,383). In addition, hysterectomy was positively related with hypertension (1.31; 95% CI 1.10-1.56; sample size: 47,831).

Hysterectomy was related to the increased risks of ischemic heart disease and hypertension. However, the evidence is not strong.