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Poorthuis MH, Yao P, Chen Y, Guo Y, Shi L, Li L, Chen Z, Clarke R, Yang L. Risks of Stroke and Heart Disease Following Hysterectomy and Oophorectomy in Chinese Premenopausal Women. Stroke 2022; 53:3064-3071. [PMID: 35862220 PMCID: PMC9508951 DOI: 10.1161/strokeaha.121.037305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Little is known about the long-term risks of stroke and ischemic heart disease (IHD) in women who had a hysterectomy alone (HA) or with bilateral oophorectomy (HBO) for benign diseases, particularly in China where the burden of cardiovascular diseases (CVD) is high. We assessed mean levels of cardiovascular risk factors and relative risks of stroke and IHD in Chinese women who had a HA or HBO. METHODS A total of 302 510 women, aged 30 to 79 years were enrolled in the China Kadoorie Biobank from 2004 to 2008 and followed up for a mean of 9.8 years. The analysis involved premenopausal women without prior cardiovascular disease or cancer at enrollment. We calculated adjusted hazard ratios for incident cases of CVD and their pathological types (ischemic stroke, hemorrhagic stroke, and IHD) after HA and HBO. Analyses were stratified by age and region and adjusted for levels of education, household income, smoking status, alcohol consumption, physical activity, body mass index, systolic blood pressure, diabetes, self-reported health, and number of pregnancies. RESULTS Among 282 722 eligible women, 8478 had HA, and 1360 had HBO. Women who had HA had 9% higher risk of CVD after HA (hazard ratio, 1.09 [95% CI, 1.06-1.12]) and 19% higher risk of CVD after HBO (1.19 [95% CI, 1.12-1.26]) compared with women who did not. Both HA and HBO were associated with higher risks of ischemic stroke and IHD but not with hemorrhagic stroke. The relative risks of CVD associated with HA and HBO were more extreme at younger age of surgery. CONCLUSIONS Women who had either HA or HBO have higher risks of ischemic stroke and IHD, and these risks should be evaluated when discussing these interventions. Additional screening for risk factors for CVD should be considered in women following HA and HBO operations, especially if such operations are performed at younger age.
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Affiliation(s)
- Michiel H.F. Poorthuis
- Clinical Trial Service Unit and Epidemiological Studies Unit (M.H.F.P., P.Y., Y.C., Z.C., R.C., L.Y.), Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Pang Yao
- Clinical Trial Service Unit and Epidemiological Studies Unit (M.H.F.P., P.Y., Y.C., Z.C., R.C., L.Y.), Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Yiping Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit (M.H.F.P., P.Y., Y.C., Z.C., R.C., L.Y.), Nuffield Department of Population Health, University of Oxford, United Kingdom
- Medical Research Council Population Health Research Unit (MRC PHRU) (Y.C., L.Y.), Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Yu Guo
- Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing (Y.G.)
| | - Liya Shi
- The First Affiliated Hospital of Hainan Medical College, Haikou, Hainan, China (L.S.)
| | - Liming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Sciences Center, Beijing, China (L.L.)
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit (M.H.F.P., P.Y., Y.C., Z.C., R.C., L.Y.), Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Robert Clarke
- Clinical Trial Service Unit and Epidemiological Studies Unit (M.H.F.P., P.Y., Y.C., Z.C., R.C., L.Y.), Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Ling Yang
- Clinical Trial Service Unit and Epidemiological Studies Unit (M.H.F.P., P.Y., Y.C., Z.C., R.C., L.Y.), Nuffield Department of Population Health, University of Oxford, United Kingdom
- Medical Research Council Population Health Research Unit (MRC PHRU) (Y.C., L.Y.), Nuffield Department of Population Health, University of Oxford, United Kingdom
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What We Know about the Long-Term Risks of Hysterectomy for Benign Indication-A Systematic Review. J Clin Med 2021; 10:jcm10225335. [PMID: 34830617 PMCID: PMC8622061 DOI: 10.3390/jcm10225335] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 11/02/2021] [Accepted: 11/06/2021] [Indexed: 12/29/2022] Open
Abstract
Hysterectomy is the most common treatment option in women with uterine fibroids, providing definitive relief from the associated burdensome symptoms. As with all surgical interventions, hysterectomy is associated with risk of complications, short-term morbidities, and mortality, all of which have been described previously. However, information on the potential long-term risks of hysterectomy is only recently becoming available. A systematic literature review was performed to identify studies published between 2005 and December 2020 evaluating the long-term impact of hysterectomy on patient outcomes. A total of 29 relevant studies were identified. A review of the articles showed that hysterectomy may increase the risk of cardiovascular events, certain cancers, the need for further surgery, early ovarian failure and menopause, depression, and other outcomes. It is important to acknowledge that the available studies examine possible associations and hypotheses rather than causality, and there is a need to establish higher quality studies to truly evaluate the long-term consequences of hysterectomy. However, it is of value to consider these findings when discussing the benefits and risks of all treatment options with patients with uterine fibroids to allow for preference-based choices to be made in a shared decision-making process. This is key to ensuring that patients receive the treatment that best meets their individual needs.
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Impact of hysterectomy on cardiovascular disease and different subtypes: a meta-analysis. Arch Gynecol Obstet 2021; 305:1255-1263. [DOI: 10.1007/s00404-021-06240-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 09/07/2021] [Indexed: 10/20/2022]
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