Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, SE-171 77 Stockholm, Sweden.
Eur Heart J. 2011 Mar;32(6):745-50. doi: 10.1093/eurheartj/ehq477. Epub 2010 Dec 24.
Hysterectomy for benign indications is one of the commonest surgical procedures in women, but the association between the procedure and cardiovascular disease (CVD) is not fully understood. In this population-based cohort study, we studied the effects of hysterectomy, with or without oopherectomy, on the risk of later life CVD.
Using nationwide healthcare registers, we identified all Swedish women having a hysterectomy on benign indications between 1973 and 2003 (n = 184,441), and non-hysterectomized controls (n = 640,043). Main outcome measure was the first hospitalization or death of incident CVD (coronary heart disease, stroke, or heart failure). Occurrence of CVD was determined by individual linkage to the Inpatient Register. In women below age 50 at study entry, hysterectomy was associated with a significantly increased risk of CVD during follow-up [hazard ratio (HR), 1.18, 95% confidence interval (CI), 1.13-1.23; HR, 2.22, 95% CI, 1.01-4.83; and HR, 1.25, 95% CI, 1.06-1.48; in women without oopherectomy, with oopherectomy before or at study entry, respectively, using women without hysterectomy or oopherectomy as reference]. In women aged 50 or above at study entry, there were no significant associations between hysterectomy and incident CVD.
Hysterectomy in women aged 50 years or younger substantially increases the risk for CVD later in life and oopherectomy further adds to the risk of both coronary heart disease and stroke.
因良性指征而行子宫切除术是女性最常见的手术之一，但该手术与心血管疾病（CVD）之间的关系尚未完全明确。在这项基于人群的队列研究中，我们研究了子宫切除术（伴或不伴卵巢切除术）对晚年 CVD 风险的影响。
我们利用全国性医疗保健登记处，确定了 1973 年至 2003 年间因良性指征行子宫切除术的所有瑞典女性（n=184441 例），并确定了未行子宫切除术的对照组（n=640043 例）。主要观察指标为首次因 CVD（冠心病、中风或心力衰竭）住院或死亡。通过个体与住院患者登记处的链接确定 CVD 的发生情况。在研究开始时年龄低于 50 岁的女性中，子宫切除术与随访期间 CVD 的风险显著增加相关[风险比（HR），1.18；95%置信区间（CI），1.13-1.23；HR，2.22；95%CI，1.01-4.83；HR，1.25；95%CI，1.06-1.48；在未行卵巢切除术、在研究开始前或同时行卵巢切除术的女性中，分别以未行子宫切除术或卵巢切除术的女性作为参照]。在研究开始时年龄为 50 岁或以上的女性中，子宫切除术与 CVD 之间无显著关联。
50 岁及以下女性的子宫切除术极大地增加了晚年 CVD 的风险，而卵巢切除术进一步增加了冠心病和中风的风险。
