Association of Early Hysterectomy With Risk of Cardiovascular Disease in Korean Women

Key PointsQuestionIs early hysterectomy before natural menopause in women associated with an increased risk of cardiovascular disease (CVD)? FindingsIn this Korean nationwide cohort study including 135575 women, early surgical hysterectomy before age 50 years was independently associated with an increased risk of CVD, especially stroke. Even after excluding women who underwent oophorectomy, the hysterectomy group had higher risks of CVD than the nonhysterectomy group. MeaningThis study noted an association between early hysterectomy and an increased risk of CVD; because the incidence of CVD was not high, a change in clinical practice may not be needed. ImportanceWomen who undergo surgical hysterectomy before natural menopause may have an earlier increase in hematocrit and storage iron levels than those who continue menstruation, thereby increasing the risk of cardiovascular disease (CVD) at ages younger than usually seen. Examining this issue may provide important implications for women's cardiovascular health to both physicians and patients. ObjectiveTo evaluate the association of hysterectomy with the risk of incident CVD among women before age 50 years. Design, Setting, and ParticipantsIn this Korean population-based cohort study, 135575 women aged 40 to 49 years were evaluated from January 1, 2011, to December 31, 2014. After propensity score matching in covariates including age, socioeconomic status, region, Charlson Comorbidity Index, hypertension, diabetes, dyslipidemia, menopause, menopausal hormone therapy, and adnexal surgery before inclusion, 55539 pairs were included in the hysterectomy and nonhysterectomy groups. Participants were followed up until December 31, 2020. Data analysis was conducted from December 20, 2021, to February 17, 2022. Main Outcomes and MeasuresThe primary outcome was an incidental CVD, a composite of myocardial infarction, coronary artery revascularization, and stroke. The individual components of the primary outcome were also evaluated. ResultsA total of 55 539 pairs were included; median age in the combined groups was 45 (IQR, 42-47) years. During median follow-up periods in the hysterectomy group of 7.9 (IQR, 6.8-8.9) years and nonhysterectomy group of 7.9 (IQR, 6.8-8.8) years, the incidence of CVD was 115 per 100000 person-years for the hysterectomy group and 96 per 100000 person-years for the nonhysterectomy group. After adjusting for confounding factors, the hysterectomy group had an increased risk of CVD compared with the nonhysterectomy group (hazard ratio [HR], 1.25; 95% CI, 1.09-1.44). The incidences of myocardial infarction and coronary artery revascularization were comparable between the groups, whereas the risk of stroke was significantly higher in the hysterectomy group (HR, 1.31; 95% CI, 1.12-1.53). Even after excluding women who underwent oophorectomy, the hysterectomy group had higher risks of CVD (HR, 1.24; 95% CI, 1.06-1.44). Conclusions and RelevanceThe findings of this cohort study suggest early menopause owing to hysterectomy was associated with increased risks for a composite of CVD, particularly stroke. This cohort study examines the incidence of cardiovascular disease in Korean women who undergo hysterectomy when younger than 50 years.