[Statistical study of the risk of cardiovascular disease in hysterectomized patients].

The risk of atherosclerotic or hypertensive cardiovascular disease increases after physiological or surgical menopause, irrespective of whether or not the ovaries are removed. In order to evaluate the direct contribution of the uterus in cutting down the incidence of cardiovascular diseases, the clinical records of 1551 cardiovascular patients and 296 healthy women were examined. All subjects were divided into 8 different groups according to their age. The following data were considered: 1) the incidence of cardiovascular diseases; 2) the number of subjects in physiological or surgical menopause; 3) the number of women hysterectomised in premenopause; 4) the number of women who underwent hysterectomy and bilateral salpingo-oophorectomy in premenopause; 5) the number of women who underwent either operation before or after the menopause. It was found that both in hysterectomised and not hysterectomised women the hypertensive and ischaemic cardiovascular pathologies prevailed in the younger and older groups respectively. Among the patients with cardiovascular diseases the percentage of subjects who had undergone hysterectomy or hysterectomy with bilateral oophorectomy was significantly higher (p less than 0.05) than in the controls. The difference was particularly marked in the younger groups. These data indicate that when the uterus is properly stimulated by the oestrogens, is able to produce a protective factor against cardiovascular diseases. It has been suggested that this factor may be prostacyclin, a potent vasodilator and the most potent inhibitor of platelet aggregation yet discovered. The epidemiological evidence alone that premenopausal hysterectomy increases the risk of cardiovascular disease should be an important consideration in weighing the risks and benefits of the procedure. If the epidemiological data can be supported by a definite mechanism of action via prostacyclin, then current indications for hysterectomy must be carefully reconsidered.