4.4 Strengths
As far as we know, this is the first meta-analysis to explore the association between hysterectomy and CVD risk. There are several strengths in our meta-analysis. Firstly, there were a large number of participants involved in our meta-analysis which guaranteed a much greater possibility of reaching reasonable conclusions. Secondly, age at operation and ovarian status were two unnegligible factors making the relationship between hysterectomy and CVD difficult to analyze.45 Thus our results were more credible because we assessed whether the ovarian status and age of operation could affect the risk of CVD. Thirdly, considering the definition of CVD varies in different studies, it’s inaccurate to assess the risk of overall CVD. In our meta-analysis, we assessed kinds of cardiovascular diseases separately to avoid this deviation. Fourthly, a significant positive association was found from cohort studies in subgroup analysis, indicating a potential causal relationship between hysterectomy and risk of ischemic heart disease. Fifthly, there were no small-study effects in our meta-analysis.