Hysterectomy and oophorectomy ups risk of cardiovascular disease in women: AHA

UK: More intensive cardiovascular risk management is indicated in premenopausal women who had a hysterectomy (HA), with or without bilateral oophorectomy (HBO), as they are at greater risks of ischemic stroke and IHD, reports a study data published in the Stroke.

Hysterectomy (HA), surgical removal of the uterus, is one of the most common surgical procedures worldwide with nearly 400,000 HA with or without concurrent bilateral oophorectomy being performed each year, most for benign diseases. HA with concurrent bilateral oophorectomy (HBO) is sometimes performed as a prophylactic procedure to reduce the risk of ovarian cancer in women having a hysterectomy.

The incidence of cardiovascular disease (CVD) is lower in women than men, before menopause, possibly reflecting the protective effects of ovarian hormones. However, the production of ovarian hormones declines substantially after oophorectomy and after hysterectomy leading to surgical menopause. Substantial uncertainty persists about the risks of CVD and CVD subtypes associated with HA or HBO in exclusive premenopausal women.

Michiel H., University of Oxford, UK, and his research team conducted a study to assess mean levels of cardiovascular risk factors and relative risks of stroke and IHD in women who had a HA or HBO

Researchers enrolled a total of 302 510 women, aged 30 to 79 years for the study and followed up for a mean of 9.8 years. The analysis involved premenopausal women without prior cardiovascular disease or cancer at enrollment. Adjusted hazard ratios for incident cases of CVD and their pathological types (ischemic stroke, hemorrhagic stroke, and IHD) after HA and HBO were calculated. Analyses were stratified by age and region and adjusted for levels of education, household income, smoking status, alcohol consumption, physical activity, body mass index, systolic blood pressure, diabetes, self-reported health, and the number of pregnancies.

Key findings of the study,

• Among 282 722 eligible women, 8478 had HA, and 1360 had HBO.

• Compared to women who had no operation, women who were operated on for HA had a 9% (HR-1.09) and HBO had a 19% (HR-1.19) higher risk of CVD. 

• Both HA and HBO were associated with higher risks of ischemic stroke and IHD but not with hemorrhagic stroke.

• The relative risks of CVD associated with HA and HBO were more extreme in surgery performed at a younger age.

The authors conclude that women who had either HA or HBO are at higher risks of ischemic stroke and IHD, and these risks should be evaluated while discussing these interventions. More intensive cardiovascular risk management is indicated in such women. Additional screening for risk factors for CVD should be considered in women following HA and HBO operations, especially if such operations are performed at a younger age.

Moreover, treatment of the women at high risk of CVD following HA and HBO with hormone replacement therapy may reduce the risks of atherosclerotic disease due to early loss of endogenous hormones, the authors wrote.

Reference:

Poorthuis MHF, Pang Yao, Yiping Chen, Yu Guo et al "Risks of stroke and heart disease following hysterectomy and oophorectomy in Chinese premenopausal women" Stroke 2022; DOI: 10.1161/STROKEAHA.121.037305.