title: Risk of cardiovascular disease by hysterectomy status, with and without oophorectomy: the Women's Health Initiative Observational Study.
abstract: 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.
  
  
  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.
authors.affiliation: MedStar Research Institute, Washington, DC, USA. Barbara.V.Howard@MedStar.net
authors.forename: Barbara V
authors.initials: BV
authors.lastname: Howard
authors.forename: Lewis
authors.initials: L
authors.lastname: Kuller
authors.forename: Robert
authors.initials: R
authors.lastname: Langer
authors.forename: JoAnn E
authors.initials: JE
authors.lastname: Manson
authors.forename: Catherine
authors.initials: C
authors.lastname: Allen
authors.forename: Annlouise
authors.initials: A
authors.lastname: Assaf
authors.forename: Barbara B
authors.initials: BB
authors.lastname: Cochrane
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Larson
authors.forename: Norman
authors.initials: N
authors.lastname: Lasser
authors.forename: Monique
authors.initials: M
authors.lastname: Rainford
authors.forename: Linda
authors.initials: L
authors.lastname: Van Horn
authors.forename: Marcia L
authors.initials: ML
authors.lastname: Stefanick
authors.forename: Maurizio
authors.initials: M
authors.lastname: Trevisan
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology*; D005006:Ethnicity; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D015994:Incidence; D008875:Middle Aged; D015999:Multivariate Analysis; D010052:Ovariectomy; D017698:Postmenopause; D012307:Risk Factors