Impact of hysterectomy on cardiovascular disease and different subtypes: a meta-analysis

Abstract

Purpose: To explore the association between hysterectomy and cardiovascular disease (CVD).

Methods: Observational studies from eight databases and reference lists of relevant studies were systematically searched up to January 2021. Pooled relative risks (RRs) and 95% CIs were calculated by the random-effects model. Subgroup analyses and meta-regressions were performed to explore potential sources of heterogeneity. Small-study effects were estimated by Egger's test and funnel plot.

Results: Seventeen studies from 14 articles were included in our meta-analysis. Hysterectomy was positively related to CVD (1.16; 95% CI 1.03-1.30; sample size: 1,233,495). For the subtype, ischemic heart disease, the pooled RR (95% CI) for hysterectomy versus non-hysterectomy was 1.20 (95% CI 1.08-1.35; sample size: 1,210,504), and the pooled HR (95% CI) was 1.15 (95% CI 1.03-1.29; sample size: 1,181,924). In the association between ischemic heart disease and hysterectomy with ovarian preservation (1.33; 95% CI 1.05-1.68; sample size: 29,058) or hysterectomy with oophorectomy (1.31; 95% CI 1.02-1.67; sample size: 23,257), significant positive associations were observed. A significant association was also found with having hysterectomy before 50 years (1.19; 95% CI 1.01-1.41; sample size: 515,297), but not with after 50 years (1.16; 95% CI 0.87-1.54; sample size: 398,383). In addition, hysterectomy was positively related with hypertension (1.31; 95% CI 1.10-1.56; sample size: 47,831).

Conclusion: Hysterectomy was related to the increased risks of ischemic heart disease and hypertension. However, the evidence is not strong.

Keywords: Age at hysterectomy; Cardiovascular disease; Hysterectomy; Ischemic heart disease; Oophorectomy; Ovarian preservation.