Cardiovascular diseases attributable to hysterectomy: a population-based study

Abstract

Background: Previous studies have confirmed an association between hysterectomy and an increased risk of cardiovascular diseases (CVDs), although some controversy remains. The aim of this study was to ascertain the attributable fraction (AF) of CVD due to hysterectomy.

Study design: A cross-sectional study based on a random sample of 2,514 Finnish women aged 30-99 was carried out. Associations between hysterectomy and CVD were analysed using multivariate analyses. By considering hysterectomy as an indicator for risk of CVD rather than the cause of CVD, based on our results the AF and population attributable fraction (PAF) were calculated for conditions associated with hysterectomy.

Results: Some 33% of women aged 50 or older had undergone hysterectomy. In the univariate analyses, hysterectomy was significantly associated with hypertension, medication for hypertension, angina pectoris, stroke, age, education, oral contraceptive use, hormone replacement therapy (HRT), higher body mass index (BMI), fasting blood glucose and cholesterol. The fully-adjusted ORs for association between CVD and hysterectomy were dramatically lower than the crude ORs, and remained significant only for medication for hypertension. The proportion of hypertension among hysterectomised women that would be prevented if none had been hysterectomised (AF) was 19.6%, while the preventable proportion of hypertension among the female population that would be prevented if none had been hysterectomised (PAF) was 3.4%. For current use of medication the AF was 51.9% and the PAF was 13.5%. The AF of hysterectomy for stroke was 43.8% and the PAF was 10.2%.

Conclusion: After adjusting for cardiovascular risk factors, we found no association between hysterectomy and ischemic heart diseases. The crude and age-adjusted associations found for some CVDs are most probably due to the more adverse initial risk profile of women who had undergone hysterectomy. The presented AF and PAF are related to indications of hysterectomy (such as uterine fibroids) rather than to the operation itself. There is a need to evaluate the cardiovascular risk factors of women with indications for hysterectomy.