Benign Hysterectomy and Risk of Cardiometabolic Disease: A Population-based Cohort Study

Hysterectomy is the most frequently performed surgery in nonpregnant women yet might have underappreciated implications for long-term chronic disease risk. In this study we investigated the association between benign hysterectomy with ovarian conservation and future risk of cardiometabolic disease.

This was a population-based cohort study of women aged 20-39 years in Alberta (1997-2021) and included: (1) an overall cohort with all eligible women (n = 1,191,263); and (2) a matched subcohort of exposed women (n = 45,331) age-matched with 6 unexposed women (n = 271,986). The primary outcome was first diagnosis of cardiometabolic disease and secondary outcomes were 10 cardiometabolic diseases. We used Cox proportional hazards regression modelling with age as the time scale (median follow-up, 13.3 years) in the overall cohort, and Royston-Parmar models with time since surgery as the time scale (median follow-up, 10.3 years) in the age-matched subcohort. Models were adjusted for birth year or year of hysterectomy, and time-varying rural residence, material deprivation quintile, continuity of primary care, and comorbidities.

In the overall cohort, hysterectomy was associated with accelerated time to first diagnosis of cardiometabolic disease (adjusted hazard ratio [aHR], 1.33; 95% confidence interval [CI], 1.30-1.36) and with incidence of 7/10 cardiometabolic diseases; the strongest associations were chronic kidney disease (aHR, 1.29; 95% CI, 1.23-1.35), ischemic heart disease (aHR, 1.31; 95% CI, 1.25-1.38), metabolic dysfunction-associated steatotic liver disease (aHR, 1.43; 95% CI, 1.32-1.55), and stroke (aHR, 1.33; 95% CI, 1.23-1.45). Results were similar in the age-matched subcohort.

Benign hysterectomy with ovarian conservation might be an important female-specific risk factor for cardiometabolic disease, warranting judicious use and expanded patient counselling on potential long-term health risks.