Yeh Jong Shiuan, Cheng Hao-Min, Hsu Pai-Feng, Sung Shih-Hsien, Liu Wen-Ling, Fang Hsin-Ling, Chuang Shao-Yuan
Cardiology Division, Internal Medicine Department, Taipei Medical University Wan-Fang Hospital, Taipei, Taiwan; Department of Medicine, Taipei Medical University, Taipei, Taiwan.
Int J Cardiol. 2013 Oct 3;168(3):2616-21. doi: 10.1016/j.ijcard.2013.03.042. Epub 2013 Apr 12.
Hysterectomy is a common procedure for treatment of numerous gynecologic diseases. However, reduction of endogenous sex hormone levels has been reported in hysterectomized women, and the association of hysterectomy with the cardiovascular risk remains controversial. We aimed to investigate the influence of hysterectomy on the risk of stroke and coronary heart disease, with adjustment for traditional risk factors.
A nationwide population-based study was conducted using the Taiwan National Health Insurance database from 1 million sampling cohort data set. A total of 7605 women who underwent hysterectomy without simultaneous oophorectomy from 1997 to 2009 were identified. The control group consisted of 30,420 women without hysterectomy, selected by matching the age, hypertension, diabetes, dyslipidemia, and the commencement date of follow-up.
A total of 558 strokes and 599 coronary heart diseases (CHD) developed during a median 7.24 years follow-up. The difference was not significant between women with and without hysterectomy for stroke (2.34 vs. 2.08 per 1000 person-year, p = 0.26) and CHD (2.39 vs. 2.26, p = 0.53). However, of the women who underwent hysterectomy before 45 years, the hazard ratio of hysterectomy was 2.29 (95% CI, 1.52-3.44) for stroke and 1.14 (95% CI, 0.71-1.83) for CHD.
Categorized by the patients' age at operation, the associations between hysterectomy and the risk of stroke were different. The excess risk of stroke was observed in women who had hysterectomy before 45 years and remained significant even after accounting for baseline cardiovascular risk factors.
子宫切除术是治疗多种妇科疾病的常见手术。然而，据报道子宫切除术后女性体内内源性性激素水平会降低，子宫切除术与心血管风险之间的关联仍存在争议。我们旨在研究子宫切除术对中风和冠心病风险的影响，并对传统风险因素进行校正。
使用台湾全民健康保险数据库中100万抽样队列数据集进行一项全国性基于人群的研究。共确定了1997年至2009年间7605例未同时行卵巢切除术的子宫切除女性。对照组由30420例未行子宫切除术的女性组成，通过匹配年龄、高血压、糖尿病、血脂异常及随访开始日期进行选择。
在中位7.24年的随访期间，共发生558例中风和599例冠心病（CHD）。子宫切除组和未切除组女性中风发生率差异无统计学意义（每1000人年分别为2.34和2.08，p = 0.26），冠心病发生率差异也无统计学意义（分别为2.39和2.26，p = 0.53）。然而，在45岁之前接受子宫切除术的女性中，子宫切除术导致中风的风险比为2.29（95%CI，1.52 - 3.44），冠心病的风险比为1.14（95%CI，0.71 - 1.83）。
按手术时患者年龄分类，子宫切除术与中风风险之间的关联有所不同。45岁之前接受子宫切除术的女性中风风险增加，即使在考虑基线心血管风险因素后仍具有统计学意义。
