Previous studies suggested that women women who have hysterectomies in midlife may be at increased for cardiovascular disease. Now, a prospective study of more than 3000 women indicates no association between hysterectomy and an increase in cardiovascular risk factors.
The study, by Karen A. Matthews, PhD, distinguished professor of psychiatry and professor of epidemiology and psychology at the University of Pittsburgh, Pennsylvania, and colleagues, was published online May 14 in the Journal of the American College of Cardiology.
The authors concede that quite a few previous studies have suggested a link between hysterectomy, with or without removal of ovaries, and CVD risk. However, they emphasize, those studies were retrospective in design, and were thus inherently limited.
“Because these studies only assessed CVD risk factors years after hysterectomy and/or oophorectomy, without assessment of pre-surgery CVD risk factors levels, it is unknown if elevated CVD risk led to the conditions warranting a surgical menopause or if CVD risk was accelerated post-surgery,” the authors write.
Therefore, Dr. Matthews and colleagues assessed 3302 premenopausal women annually for 11 years. All participants were enrolled in the Study of Women’s Health Across the Nation (SWAN), which is a multisite, community-based prospective study aimed at tracking the physical and psychological health of women as they transition through menopause.
The study population was ethnically diverse, and all participants were aged 42 to 52 years at the time of entry into the study. None of the women were using hormone therapy at baseline.
The investigators factored in such variables as sociodemographic characteristics, menopausal status, surgeries, body mass index, use of medications, lifestyle factors, lipids, blood pressure, insulin resistance, and hemostatic and inflammatory indices.
For women who underwent elective hysterectomy with and without removal of ovaries, the investigators compared risk factors for CVD both before and after surgery. They then compared those results with results from women who underwent natural menopause.
The researchers found that in women who underwent hysterectomy, several risk factors for CVD did vary somewhat, both before and after surgery, compared with changes in women who experienced natural menopause. However, they say, those changes would not suggest increased CVD risk after hysterectomy. They do note that body mass index increased after hysterectomy that included oophorectomy.
There may be several reasons the new findings differ from those of previous studies, according to the authors. One might be the age of the SWAN participants: It might be that hysterectomies taking place earlier in life could be linked to additional CVD risk. In addition, prior studies included women who had undergone hysterectomy for any reason, whereas the SWAN study excluded women who had hysterectomies because of cancer.
“These results should provide reassurance to women and their clinicians that hysterectomy with or without ovarian conservation in mid-life is not likely to substantially accelerate women’s CVD risk,” the authors conclude.
SWAN has received grant support from the National Institutes of Health through the National Institute on Aging, the National Institute of Nursing Research, and the Office of Research on Women’s Health. The authors have disclosed no relevant financial relationships.
J Am Coll Cardiol. Published online May 14, 2013.
— Steven Fox
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