CARDIOVASCULAR MORBIDITY IN RELATION TO OVARIAN-FUNCTION AFTER HYSTERECTOMY

Objective: To determine if removal of the uterus with ovarian preserva tion is associated with cardiovascular morbidity and risk factors. Met hods: Self-reported histories of gynecologic surgery of 3895 women fro m 40 regions in Finland, 30-95 years old, were collected in 1977-1980, and 78% of hysterectomies were confirmed from the hospital records. C ardiovascular risk factors (total- and high-density lipoprotein choles terol, education, body mass index [BMI], blood glucose, and triglyceri des), parity, and current use of hormone replacement therapy were used to adjust the risk of hypertension (less than 60 years old and diasto lic blood pressure [BP] at least 95 mmHg, or 60 years older and diasto lic BP at least 100 mmHg), coronary heart disease, and heart failure. The women with unconfirmed hysterectomies and missing information on c ardiovascular risk factors were excluded. Thereafter, the final number of subjects included in the analysis was 3780. Results: One or no ova ry was removed in 163 hysterectomies, and in 55 cases, both ovaries we re removed. Women with hysterectomy and preservation of at least one o vary had significantly higher diastolic BP and higher BMI than those w ho had not undergone hysterectomy. Women with hysterectomy and ovarian preservation also had a significantly increased risk of hypertension (odds ratio 2.2, 95% confidence interval 1.5-3.1). The risks of other heart diseases (angina pectoris, myocardial infarction, and heart fail ure) were not significantly increased. Conclusion: Hysterectomy with o varian preservation is associated with increased risk of high diastoli c BP, diagnosis of hypertension, and increased BMI, but not with other heart diseases. Either hysterectomy increases the risk of hypertensio n or the increase of BP and the development of myomas, which often lea d to hysterectomy, are explained by a common pathogenetic mechanism.