In general, postmenopausal women experience elevated risks of coronary artery disease and stroke, causing an increase in cardiovascular disease (CVD)-related morbidity and mortality in this population.¹ The loss of menstruation after hysterectomy may result in hemorheologic deleterious effect, leading to an elevated blood viscosity, further promoting endothelial injury, rupture of plaques, and thrombus formation.¹ As such, women who received hysterectomy before natural menopause, theoretically, are also likely to be at an elevated risk of CVD, since they may experience an earlier increase in hematocrit and storage iron levels.¹  

The intricate relationship between hysterectomy and the associated risk of CVD in women has been well documented in the literature.^2,3 For instance, a population-based cohort study conducted in the United States (US) found that an increased long-term risk of CVD was associated with women who underwent hysterectomy without oophorectomy.² Meanwhile, another Taiwanese population-based cohort study had somewhat contradicting results, indicating that the elevated risks of coronary heart disease, CVD and stroke were only prevalent among premenopausal women aged <45 years who underwent hysterectomy, while no significant difference in the CVD risk was observed among postmenopausal women aged ≥45 years, regardless of receiving any hysterectomy treatment.³ Hence, there is a need for more population-based analysis to determine the association between hysterectomy and the elevated CVD risk in women. 

A nationwide, population-based, retrospective, observational study was conducted in Korea to determine the relationship between hysterectomy and CVD risk among women aged <50 years.¹ From January 1, 2007 to December 31, 2020, a total of 135,575 adult Korean women aged 40-49 years were included in this study, of which 49.1% had received hysterectomy.¹ The primary endpoint of this observational study was the incidence of CVD, which was defined as the first hospitalization for, or death due to myocardial infarction (MI), coronary artery revascularization (CAR), or stroke.¹  

With a median follow-up period of 7.9 years, the analysis revealed that the incidence of CVD was 115 per 100 000 person-years for the hysterectomy group and 96 per 100 000 person-years for the non-hysterectomy group.¹ Hence, participants in the hysterectomy group were 25% more suspectable to develop CVD compared with the non-hysterectomy group (HR=1.25; 95% CI: 1.09-1.44; p=0.002).¹ Both patient groups exhibited similar risks of MI (HR=1.06; 95% CI: 0.56-2.02; p=0.86) and CAR (HR=1.03, 95% CI: 0.74-1.43; p=0.85).¹ Notably, patients in the non-hysterectomy group had a significantly elevated risk of stroke when compared with the non-hysterectomy group (HR=1.31; 95% CI: 1.12-1.53; p<0.001).¹ 

In summary, the study results demonstrated that hysterectomy was highly associated with a heightened risk of CVD, particularly stroke, among women younger than 50 years, thus providing a clear connection between hysterectomy and the elevated CVD risk in postmenopausal women.¹ However, the incidence of CVD among women who underwent hysterectomy was minuscule. Hence, the existing clinical standards remain adequate and the current clinical practices should not be modified.¹