Study Suggests Hysterectomy Does Not Increase CVD Risk
Having a hysterectomy with or without bilateral oophorectomyin mid-life does not increase a woman's risk of cardiovascular disease compared to women who reach natural menopause, contrary to many previously reported studies, according to research published in the Journal of the American College of Cardiology.
"Middle-aged women who are considering hysterectomy should be encouraged because our results suggest that increased levels of cardiovascular risk factors are not any more likely after hysterectomy relative to after natural menopause," said Karen A. Matthews, PhD, lead author of the study and a distinguished professor of psychiatry and professor of epidemiology and psychology at the University of Pittsburgh.
The study, which is the only multiethnic study to track prospective annual changes in cardiovascular disease risk factors relative to hysterectomy or natural menopause, followed 3,302 premenopausal women between the ages of 42-52 for 11 years who were enrolled in the Study of Women's Health across the Nation (SWAN). Study investigators compared cardiovascular disease risk factors in women prior to and following elective hysterectomy with or without ovary removal to the risk factors prior to and following final menstrual period in women who underwent natural menopause.
Overall, the study found that while several cardiovascular disease risk factors changed prior to and following hysterectomy, compared to changes prior to and following a natural menopause, these changes did not occur in a pattern suggesting an increased cardiovascular disease risk following hysterectomy. For example, data showed that prior to hysterectomy with ovarian conservation, triglycerides and tPA changes declined and ApoA increased, compared to the changes prior to natural menopause, suggesting a lower risk trajectory among these women pre-surgically. Prior to hysterectomy with bilateral oophorectomy, CRP increases were greater than prior to a natural menopause but no differences occurred after surgery, compared to after final menstrual period. Study investigators did note that body mass index was the one risk factor that increased after hysterectomy with removal of ovaries. The effects were similar in all ethnic groups in the study.
According to Matthews, it is unclear why the study's findings differed from other studies exploring hysterectomy and cardiovascular risk, but likely factors include the age of participants since hysterectomy that occurs earlier in life may present more cardiovascular risk. Also, earlier studies included women who had hysterectomy for any reason, whereas the SWAN study excluded women who had hysterectomy because of cancers.
"This study will prove very reassuring to women who have undergone hysterectomy," said American College of Cardiology CardioSmart Chief Medical Expert JoAnne Foody, MD, FACC. "As with anything, if a woman is concerned about her risk for heart disease she should discuss this with her health care provider."
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