Risk of cardiovascular disease by hysterectomy status, with and without oophorectomy - The Women's Health Initiative Observational Study

Background - Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in women and may vary by hysterectomy ( or oophorectomy) status. This study compared CVD risk factors and rates between postmenopausal women who had and had not undergone hysterectomy, with or without oophorectomy. Methods and Results - This analysis was conducted on 89 914 women in the Women's Health Initiative (WHI) Observational Study. Participants reported demographic characteristics, medical history, dietary habits, physical activity, medications, and previous hysterectomy ( with or without oophorectomy). Baseline weight, height, waist circumference, and blood pressure were measured. CVD events were ascertained during 5.1 years of mean follow-up and adjudicated with standard criteria. Black, Hispanic, and American Indian women had higher rates of hysterectomy than white women (52.9%, 44.6%, and 49.2% versus 40.0%, respectively), and Asian/Pacific Islander women had lower rates (33.8%). Women with a hysterectomy ( regardless of oophorectomy status) had an adverse risk profile at baseline compared with women with no hysterectomy, including a higher proportion of hypertension, diabetes, high cholesterol, obesity, and lower education, income, and physical activity ( all P < 0.01). Total mortality and fatal and nonfatal CVD were higher among women with a hysterectomy. Hysterectomy ( regardless of oophorectomy status) was a significant predictor of CVD (HR: 1.26, P < 0.001). After adjustment for demographic variables and CVD risk factors, the effect was reduced and nonsignificant. Conclusions - Women with a hysterectomy had a worse risk profile and higher prevalence and incidence of CVD in this cohort. Multivariate models suggest that hysterectomy is not the major determinant of this outcome; rather, CVD risk may be due to the more adverse initial risk profile of women who had undergone hysterectomy.