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(Circulation. 2005;111:1462-1470.)
© 2005 American Heart Association, Inc.

Epidemiology

Risk of Cardiovascular Disease by Hysterectomy Status, With and Without Oophorectomy

The Women’s Health Initiative Observational Study

Barbara V. Howard, PhD; Lewis Kuller, MD; Robert Langer, MD; JoAnn E. Manson, MD; Catherine Allen, PhD; Annlouise Assaf, PhD; Barbara B. Cochrane, PhD, RN; Joseph C. Larson, MS; Norman Lasser, MD; Monique Rainford, MD; Linda Van Horn, PhD; Marcia L. Stefanick, PhD; Maurizio Trevisan, MD

From the MedStar Research Institute (B.V.H., M.R.), Washington, DC; University of Pittsburgh (L.K.), Pittsburgh, Pa; UCSD School of Medicine (R.L.), La Jolla, Calif; Brigham and Women’s Hospital (J.E.M.), Harvard Medical School, Boston, Mass; University of Wisconsin (C.A.), Madison, Wis; The Memorial Hospital of Rhode Island (A.A.), Pawtucket, RI; Fred Hutchinson Cancer Research Center (B.B.C.), Seattle, Wash; University of Medicine and Dentistry of New Jersey (N.L.), Newark, NJ; Northwestern University (L.V.H.), Chicago, Ill; Stanford School of Medicine (M.L.S.), Stanford, Calif; and Buffalo General Hospital (M.T.), Buffalo, NY.

Correspondence to Barbara V. Howard, MedStar Research Institute, 6495 New Hampshire Ave, Suite 201, Hyattsville, MD 20783. E-mail Barbara.V.Howard{at}MedStar.net

Received July 27, 2004; revision received December 22, 2004; accepted December 27, 2004.

Background— Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in women and may vary by hysterectomy (or oophorectomy) status. This study compared CVD risk factors and rates between postmenopausal women who had and had not undergone hysterectomy, with or without oophorectomy.

Methods and Results— This analysis was conducted on 89 914 women in the Women’s Health Initiative (WHI) Observational Study. Participants reported demographic characteristics, medical history, dietary habits, physical activity, medications, and previous hysterectomy (with or without oophorectomy). Baseline weight, height, waist circumference, and blood pressure were measured. CVD events were ascertained during 5.1 years of mean follow-up and adjudicated with standard criteria. Black, Hispanic, and American Indian women had higher rates of hysterectomy than white women (52.9%, 44.6%, and 49.2% versus 40.0%, respectively), and Asian/Pacific Islander women had lower rates (33.8%). Women with a hysterectomy (regardless of oophorectomy status) had an adverse risk profile at baseline compared with women with no hysterectomy, including a higher proportion of hypertension, diabetes, high cholesterol, obesity, and lower education, income, and physical activity (all P<0.01). Total mortality and fatal and nonfatal CVD were higher among women with a hysterectomy. Hysterectomy (regardless of oophorectomy status) was a significant predictor of CVD (HR: 1.26, P<0.001). After adjustment for demographic variables and CVD risk factors, the effect was reduced and nonsignificant.

Conclusions— Women with a hysterectomy had a worse risk profile and higher prevalence and incidence of CVD in this cohort. Multivariate models suggest that hysterectomy is not the major determinant of this outcome; rather, CVD risk may be due to the more adverse initial risk profile of women who had undergone hysterectomy.

Key Words: hysterectomy • mortality • cardiovascular disease • risk factors

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