Cardiovascular and metabolic morbidity after hysterectomy with ovarian conservation: a cohort study

Abstract

Objective: The aim of the study was to determine the long-term risk of cardiovascular disease and metabolic conditions in women undergoing hysterectomy with bilateral ovarian conservation compared with age-matched referent women.

Methods: Using the Rochester Epidemiology Project records-linkage system, we identified 2,094 women who underwent hysterectomy with ovarian conservation for benign indications between 1980 and 2002 in Olmsted County, Minnesota. Each woman was age-matched (±1 y) to a referent woman residing in the same county who had not undergone prior hysterectomy or any oophorectomy. These two cohorts were followed historically to identify de novo cardiovascular or metabolic diagnoses. We estimated hazard ratios (HRs) and 95% CIs using Cox proportional hazards models adjusted for 20 preexisting chronic conditions and other potential confounders. We also calculated absolute risk increases and reductions from Kaplan-Meier estimates.

Results: Over a median follow-up of 21.9 years, women who underwent hysterectomy experienced increased risks of de novo hyperlipidemia (HR 1.14; 95% CI, 1.05-1.25), hypertension (HR 1.13; 95% CI, 1.03-1.25), obesity (HR 1.18; 95% CI, 1.04-1.35), cardiac arrhythmias (HR 1.17; 95% CI, 1.05-1.32), and coronary artery disease (HR 1.33; 95% CI, 1.12-1.58). Women who underwent hysterectomy at age ≤35 years had a 4.6-fold increased risk of congestive heart failure and a 2.5-fold increased risk of coronary artery disease.

Conclusions: Even with ovarian conservation, hysterectomy is associated with an increased long-term risk of cardiovascular and metabolic conditions, especially in women who undergo hysterectomy at age ≤35 years. If these associations are causal, alternatives to hysterectomy should be considered to treat benign gynecologic conditions.

Fig. 1

Cumulative incidence curves for cardiovascular and metabolic conditions in women who underwent hysterectomy with ovarian conservation compared with age-matched referent women (overall analyses). The curves were adjusted using inverse probability weights derived from a logistic regression model including all 20 chronic conditions present at baseline, years of education (≤12, 13-16, >16, unknown), race (white vs nonwhite), and age and calendar year at baseline (continuous). The number of women at risk varied across conditions because we excluded women with that specific condition on the index date. The hazard ratios (HRs) and corresponding 95% confidence intervals were calculated using Cox proportional hazards models with age as the time scale and adjusted using inverse probability weights. Note the different scales used for the y-axis to better show differences.

Fig. 2

Cumulative incidence curves for cardiovascular and metabolic conditions in women who underwent hysterectomy with ovarian conservation at 35 years or younger compared with age-matched referent women (stratified analyses). The curves were adjusted using inverse probability weights derived from a logistic regression model restricted to this age stratum, and including all 20 chronic conditions present at baseline, years of education (≤12, 13-16, >16, unknown), race (white vs nonwhite), and age and calendar year at baseline (continuous). The number of women at risk varied across conditions because we excluded women with that specific condition on the index date. The hazard ratios (HRs) and corresponding 95% confidence intervals were calculated using Cox proportional hazards models with age as the time scale and adjusted using inverse probability weights. Note the different scales used for the y-axis to better show differences.