A study of 239,907 women from the Nurses’ Health Study (NHS) and NHS II examined cardiovascular disease (CVD) risk after hysterectomy with or without oophorectomy. Results showed increased CVD risk among participants who underwent hysterectomy before age 50 years, with a 21% higher risk in those younger than 46 years who did not use estrogen.
METHODOLOGY:
A secondary analysis of survey data from the NHS and NHS II included 239,907 participants, with an average follow-up time of 34.17 years.
Primary outcome was defined as CVD, combining incidence of fatal and nonfatal myocardial infarction, coronary artery intervention (bypass graft, angioplasty, or stent), and stroke.
Secondary outcome included major adverse cardiovascular events, encompassing myocardial infarction, stroke, and death due to cardiovascular causes.
Researchers employed a multivariable Cox proportional hazards model, stratified by age in months and calendar time to estimate hazard ratios (HRs), adjusting for hormone therapy and various demographic and health-related factors.
TAKEAWAY:
Analysis revealed higher CVD disease risk among all participants who underwent hysterectomy before age 50 years than those who underwent no surgery.
Participants who had hysterectomy before age 46 years without estrogen use showed a 21.0% increased risk for CVD compared with those who underwent no surgery (HR, 1.21; 95% CI, 1.04-1.40).
Among estrogen users with hysterectomy and bilateral oophorectomy, those younger than 46 years and aged 46-50 years demonstrated higher CVD risk (HR, 1.26; 95% CI, 1.16-1.37 and HR, 1.11; 95% CI, 1.01-1.22, respectively) than those who underwent no surgery.
Nonusers who underwent hysterectomy with bilateral oophorectomy in all age groups except those older than 60 years experienced higher CVD risk than those who underwent no surgery.
IN PRACTICE:
“Younger age at time of hysterectomy, with or without oophorectomy, is associated with higher risk of CVD. Notably, use of estrogen does not appear to mitigate deleterious effects of hysterectomy with oophorectomy before age 50 years,” the authors of the study wrote.
SOURCE:
This study was led by Viengneesee Thao, PhD, from the Mayo Clinic in Rochester. It was published online in Obstetrics & Gynecology.
Courtesy Medscape Medbrief May 12, 2025 Edited by Lora McGlade
