Clinical Trial Service Unit and Epidemiological Studies Unit (M.H.F.P., P.Y., Y.C., Z.C., R.C., L.Y.), Nuffield Department of Population Health, University of Oxford, United Kingdom.
Medical Research Council Population Health Research Unit (MRC PHRU) (Y.C., L.Y.), Nuffield Department of Population Health, University of Oxford, United Kingdom.
Stroke. 2022 Oct;53(10):3064-3071. doi: 10.1161/STROKEAHA.121.037305. Epub 2022 Jul 13.
Little is known about the long-term risks of stroke and ischemic heart disease (IHD) in women who had a hysterectomy alone (HA) or with bilateral oophorectomy (HBO) for benign diseases, particularly in China where the burden of cardiovascular diseases (CVD) is high. We assessed mean levels of cardiovascular risk factors and relative risks of stroke and IHD in Chinese women who had a HA or HBO.
A total of 302 510 women, aged 30 to 79 years were enrolled in the China Kadoorie Biobank from 2004 to 2008 and followed up for a mean of 9.8 years. The analysis involved premenopausal women without prior cardiovascular disease or cancer at enrollment. We calculated adjusted hazard ratios for incident cases of CVD and their pathological types (ischemic stroke, hemorrhagic stroke, and IHD) after HA and HBO. Analyses were stratified by age and region and adjusted for levels of education, household income, smoking status, alcohol consumption, physical activity, body mass index, systolic blood pressure, diabetes, self-reported health, and number of pregnancies.
Among 282 722 eligible women, 8478 had HA, and 1360 had HBO. Women who had HA had 9% higher risk of CVD after HA (hazard ratio, 1.09 [95% CI, 1.06-1.12]) and 19% higher risk of CVD after HBO (1.19 [95% CI, 1.12-1.26]) compared with women who did not. Both HA and HBO were associated with higher risks of ischemic stroke and IHD but not with hemorrhagic stroke. The relative risks of CVD associated with HA and HBO were more extreme at younger age of surgery.
Women who had either HA or HBO have higher risks of ischemic stroke and IHD, and these risks should be evaluated when discussing these interventions. Additional screening for risk factors for CVD should be considered in women following HA and HBO operations, especially if such operations are performed at younger age.
对于因良性疾病接受单纯子宫切除术（HA）或双侧卵巢切除术（HBO）的女性，其发生中风和缺血性心脏病（IHD）的长期风险知之甚少，尤其是在中国，心血管疾病（CVD）负担沉重的情况下。我们评估了中国因良性疾病接受 HA 或 HBO 的女性发生中风和 IHD 的心血管风险因素平均水平和相对风险。
共有 302510 名年龄在 30 至 79 岁的女性于 2004 年至 2008 年参加中国慢性病前瞻性研究（CKB），平均随访 9.8 年。该分析包括入组时无心血管疾病或癌症的绝经前女性。我们计算了 HA 和 HBO 后 CVD 及各病理类型（缺血性中风、出血性中风和 IHD）发病的校正危害比。分析按年龄和地区分层，并根据教育水平、家庭收入、吸烟状况、饮酒、身体活动、体重指数、收缩压、糖尿病、自我报告健康状况和妊娠次数进行调整。
在 282722 名合格女性中，8478 名女性行 HA，1360 名女性行 HBO。与未行 HA 的女性相比，行 HA 的女性发生 CVD 的风险高 9%（危害比，1.09[95%CI，1.06-1.12]），行 HBO 的女性发生 CVD 的风险高 19%（1.19[95%CI，1.12-1.26]）。HA 和 HBO 均与缺血性中风和 IHD 的风险增加相关，但与出血性中风无关。手术年龄较小时，与 HA 和 HBO 相关的 CVD 风险的相对风险更为极端。
行 HA 或 HBO 的女性发生缺血性中风和 IHD 的风险更高，在讨论这些干预措施时应评估这些风险。应考虑在接受 HA 和 HBO 手术后的女性中进行 CVD 危险因素的额外筛查，尤其是在年龄较小的情况下。
