Abstract
Background: The association of hysterectomy with risk of cardiovascular
disease(CVD) remains unclear. Objective: To evaluate the relationship
between hysterectomy and the risk of CVD. Search Strategy: Five
databases and reference lists of relevant studies were systematically
searched up to January 2020. Selection Criteria: Observational studies
evaluating the relationship between hysterectomy and risk of CVD or its
subordinate diseases and non-hysterectomy controls were retained. Data
Collection and Analysis: Pooled relative risks (RRs) and 95% CI were
calculated by random effects model. Subgroup analyses and
meta-regressions were performed to explore potential sources of
heterogeneity. Small-study effects were estimated by Egger’s test and
funnel plot. Main Results: Fourteen articles were included in our
meta-analysis. The pooled RR (95% CI) of ischemic heart disease risk
for hysterectomy versus non-hysterectomy was 1.20 (95% CI: 1.08-1.35).
In association between ischemic heart disease and hysterectomy with
ovarian preservation or hysterectomy with oophorectomy, significant
positive associations were observed. A significant association was also
found with having hysterectomy before 50y (1.19; 95% CI:1.01-1.41),
but not with after 50y (1.16; 95% CI: 0.87-1.54). Hysterectomy might
increase the risk of hypertension and unclassified CVD, but have no
influence on other subordinate diseases of CVD. Conclusions:
hysterectomy, whether preserving ovaries or not, might increase the risk
of ischemic heart disease and hypertension, not of stroke. Hysterectomy
might increase the risk of ischemic heart disease and stroke in women
who had surgery below 50y. Keywords: hysterectomy, cardiovascular
disease, hysterectomy with ovarian preservation, hysterectomy with
oophorectomy, age at operation, meta-analysis.