1 Introduction
Hysterectomy is a common surgery in women especially for benign
gynecological diseases owing to its low perioperative morbidity and
definite therapeutic effect.1, 2 Although in recent
years, endometrial ablation has become mature gradually, it cannot
completely replace hysterectomy because the re-operation rates after
endometrial ablation including repeat ablation and hysterectomy increase
progressively over time.2 Studies have shown that
hysterectomy is associated with increased risks of many diseases, such
as bipolar disorder3, fallopian tube
prolapse4, osteoporosis5,
dementia6 and colorectal cancer7. In
addition, the association between hysterectomy and the risk of
cardiovascular disease (CVD) was found.8-16
In the 19th century, the incidence of coronary artery
disease (CAD) was found higher in male than
female.17-19 Researchers later confirmed that male
predominance depended on age20 and it disappeared in
people over 60. Meanwhile, it was found that the serum cholesterol of
women over 50 years old was significantly higher than that of young
women.21, 22 It was speculated that this phenomenon
was due to the ovarian involution after menopause. Therefore, many
observational studies assessing the association between oophorectomy and
CAD were conducted, regardless of the influence of
hysterectomy.23 In the process of exploring this
problem, negative effects of hysterectomy on CAD and other
cardiovascular diseases were recognized.17, 23
Although a lot of researches were conducted, the epidemiological
evidence of the relationship between hysterectomy and CVD is
controversial.10-14, 16, 24-27 Since hysterectomy
leads to ovarian failure by interfering with blood and nerve supply of
the ovaries, some studies showed hysterectomy would increase the risk of
CVD.10-14, 16, 28-30 However, Some researchers found
hysterectomy was not associated with risk of CVD.24-27They considered that the increased CVD risk may because of the more
adverse initial risk of CVD rather the hysterectomy
itself.24-26, 31 Therefore, we conducted a
meta-analysis to assess: (1) the relation between unclassified
hysterectomy and risk of CVD; (2) the relationship between hysterectomy
with ovarian preservation and risk of CVD; (3) the association between
hysterectomy with oophorectomy and risk of CVD; (4) whether the age of
hysterectomy will influence CVD risk.