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Association of Early Hysterectomy With Risk of Cardiovascular Disease in Korean Women
Jin-Sung Yuk1, Byung Gyu Kim2, Byoung Kwon Lee3
1Department of Obstetrics and Gynecology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea.
Insights
Hysterectomy before age 50 increases cardiovascular disease (CVD) risk, particularly stroke, in women. This finding highlights the importance of considering surgical timing for women's long-term cardiovascular health.
Area of Science:
- Cardiovascular Science
- Women's Health
- Surgical Outcomes
Background:
- Surgical hysterectomy before natural menopause may elevate hematocrit and iron levels, potentially increasing cardiovascular disease (CVD) risk at younger ages.
- Understanding this association is crucial for informing women and physicians about cardiovascular health implications.
Purpose of the Study:
- To investigate the link between hysterectomy and the risk of incident cardiovascular disease (CVD) in women under 50 years old.
Main Methods:
- A Korean population-based cohort study included 135,575 women aged 40-49.
- Propensity score matching created 55,539 pairs for hysterectomy and non-hysterectomy groups.
- Follow-up lasted until December 31, 2020, with data analyzed between 2021-2022.
Main Results:
- The hysterectomy group showed a significantly increased risk of CVD (HR, 1.25; 95% CI, 1.09-1.44) compared to the non-hysterectomy group.
- While myocardial infarction and coronary revascularization rates were similar, stroke risk was notably higher in the hysterectomy group (HR, 1.31; 95% CI, 1.12-1.53).
- This increased CVD risk persisted even when excluding women who underwent oophorectomy.
Conclusions:
- Early menopause induced by hysterectomy is associated with elevated risks of cardiovascular disease (CVD), especially stroke.
- These findings emphasize the need for careful consideration of hysterectomy timing in relation to women's long-term cardiovascular health.
Importance:
Women who undergo surgical hysterectomy before natural menopause may have an earlier increase in hematocrit and storage iron levels than those who continue menstruation, thereby increasing the risk of cardiovascular disease (CVD) at ages younger than usually seen. Examining this issue may provide important implications for women's cardiovascular health to both physicians and patients.
Objective:
To evaluate the association of hysterectomy with the risk of incident CVD among women before age 50 years.
Design, Setting, And Participants:
In this Korean population-based cohort study, 135 575 women aged 40 to 49 years were evaluated from January 1, 2011, to December 31, 2014. After propensity score matching in covariates including age, socioeconomic status, region, Charlson Comorbidity Index, hypertension, diabetes, dyslipidemia, menopause, menopausal hormone therapy, and adnexal surgery before inclusion, 55 539 pairs were included in the hysterectomy and nonhysterectomy groups. Participants were followed up until December 31, 2020. Data analysis was conducted from December 20, 2021, to February 17, 2022.
Main Outcomes And Measures:
The primary outcome was an incidental CVD, a composite of myocardial infarction, coronary artery revascularization, and stroke. The individual components of the primary outcome were also evaluated.
Results:
A total of 55 539 pairs were included; median age in the combined groups was 45 (IQR, 42-47) years. During median follow-up periods in the hysterectomy group of 7.9 (IQR, 6.8-8.9) years and nonhysterectomy group of 7.9 (IQR, 6.8-8.8) years, the incidence of CVD was 115 per 100 000 person-years for the hysterectomy group and 96 per 100 000 person-years for the nonhysterectomy group. After adjusting for confounding factors, the hysterectomy group had an increased risk of CVD compared with the nonhysterectomy group (hazard ratio [HR], 1.25; 95% CI, 1.09-1.44). The incidences of myocardial infarction and coronary artery revascularization were comparable between the groups, whereas the risk of stroke was significantly higher in the hysterectomy group (HR, 1.31; 95% CI, 1.12-1.53). Even after excluding women who underwent oophorectomy, the hysterectomy group had higher risks of CVD (HR, 1.24; 95% CI, 1.06-1.44).
Conclusions And Relevance:
The findings of this cohort study suggest early menopause owing to hysterectomy was associated with increased risks for a composite of CVD, particularly stroke.
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