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Increased risk of coronary heart disease with hysterectomy in young women: A longitudinal follow-up study using a national health screening cohort

  • Hyo Geun Choi
    Affiliations
    Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Anyang, Republic of Korea

    Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang, Republic of Korea
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  • Yoon Seok Koh
    Affiliations
    Division of Cardiology, Department of Obstetrics and Gynecology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
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  • Suk Woo Lee
    Correspondence
    Corresponding author.
    Affiliations
    Division of Gynecologic Reproductive Endocrinology, Department of Obstetrics and Gynecology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22 Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do 14068, Republic of Korea
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      Highlights

      • Previous studies have shown that hysterectomy is associated with an increased risk of coronary heart disease in terms of decreased estrogen and increased metabolic risk.
      • Recent studies have shown that hysterectomy is not associated with the development of coronary heart disease and that a high estrogen level is not associated with a decreased risk of coronary heart disease.
      • This study showed that the incidence of coronary heart disease was higher in women who underwent hysterectomy when they were under 50 years of age.
      • This cohort study of Korean women supports previous studies showing that hysterectomy is associated with an increased incidence of coronary heart disease in young women.

      Abstract

      Objective

      Hysterectomy is one of the most commonly performed gynecological procedures. Several studies have reported an association between hysterectomy and coronary heart disease (CHD), but the conclusions are controversial. This study aimed to evaluate the association between hysterectomy and the occurrence of CHD using a national sample cohort from South Korea.

      Study design

      Using the national cohort from the Korean National Health Insurance Service, we extracted data on patients who had undergone hysterectomy (n = 8,642) and on controls matched at a ratio of 1:4 (n = 34,568) and then analyzed the occurrence of CHD from 2002 to 2013. Patients were matched according to age, income, region of residence, obesity, smoking, alcohol consumption, and medical history.

      Main outcome measures

      A Cox proportional hazards model was used to analyze the hazard ratios (HRs) and 95% confidence intervals (CIs). Subgroup analyses were performed based on both age and bilateral salpingo-oophorectomy (BSO) status. The age of the participants was defined as that at the time of hysterectomy.

      Results

      The HR for CHD was 1.05 (95% CI = 0.96–1.16, p = 0.286) in the hysterectomy group. The HRs for CHD according to the different age subgroups were 1.19 (95% CI = 1.03–1.38, p = 0.018) for patients aged < 50 years, 1.05 (95% CI = 0.89–1.25, p = 0.561) for patients aged 50–59 years, and 0.88 (95% CI = 0.73–1.05, p = 0.147) for patients aged ≥ 60 years.

      Conclusion

      The incidence of CHD was statistically significantly higher in women who underwent hysterectomy when they were under 50 years of age than in the matched controls.

      Keywords

      Abbreviations:

      CHD (coronary heart disease), HR (hazard ratio), CI (confidence interval), BSO (bilateral salpingo-oophorectomy), CVD (cardiovascular disease), NHIS (National Health Insurance Service), ICD (international classification of diseases), SD (standard deviation), WPRO (Western Pacific Regional Office), CCI (Charlson Comorbidity Index), OR (odds ratio), POR (prevalence odds ratio), OC (oral contraceptive), HRT (hormone replacement therapy)
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