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.