Cardiovascular morbidity in relation to ovarian function after hysterectomy

Objective

To determine if removal of the uterus with ovarian preservation is associated with cardiovascular morbidity and risk factors.

Methods

Self-reported histories of gynecologic surgery of 3895 women from 40 regions in Finland, 30–95 years old, were collected in 1977–1980, and 78% of hysterectomies were confirmed from the hospital records. Cardiovascular risk factors (total- and high-density lipoprotein cholesterol, education, body mass index [BMI], blood glucose, and triglycerides), parity, and current use of hormone replacement therapy were used to adjust the risk of hypertension (less than 60 years old and diastolic blood pressure [BP] at least 95 mmHg, or 60 years older and diastolic BP at least 100 mmHg), coronary heart disease, and heart failure. The women with unconfirmed hysterectomies and missing information on cardiovascular risk factors were excluded. Thereafter, the final number of subjects included in the analysis was 3780.

Results

One or no ovary was removed in 163 hysterectomies, and in 55 cases, both ovaries were removed. Women with hysterectomy and preservation of at least one ovary had significantly higher diastolic BP and higher BMI than those who had not undergone hysterectomy. Women with hysterectomy and ovarian preservation also had a significantly increased risk of hypertension (odds ratio 2.2, 95% confidence interval 1.5–3.1). The risks of other heart diseases (angina pectoris, myocardial infarction, and heart failure) were not significantly increased.

Conclusion

Hysterectomy with ovarian preservation is associated with increased risk of high diastolic BP, diagnosis of hypertension, and increased BMI, but not with other heart diseases. Either hysterectomy increases the risk of hypertension or the increase of BP and the development of myomas, which often lead to hysterectomy, are explained by a common pathogenetic mechanism.