title: Hysterectomy in young women associates with higher risk of stroke: a nationwide cohort study.
abstract: OBJECTIVE
  Hysterectomy is a common procedure for treatment of numerous gynecologic diseases. However, reduction of endogenous sex hormone levels has been reported in hysterectomized women, and the association of hysterectomy with the cardiovascular risk remains controversial. We aimed to investigate the influence of hysterectomy on the risk of stroke and coronary heart disease, with adjustment for traditional risk factors.
  
  
  METHODS
  A nationwide population-based study was conducted using the Taiwan National Health Insurance database from 1 million sampling cohort data set. A total of 7605 women who underwent hysterectomy without simultaneous oophorectomy from 1997 to 2009 were identified. The control group consisted of 30,420 women without hysterectomy, selected by matching the age, hypertension, diabetes, dyslipidemia, and the commencement date of follow-up.
  
  
  RESULTS
  A total of 558 strokes and 599 coronary heart diseases (CHD) developed during a median 7.24 years follow-up. The difference was not significant between women with and without hysterectomy for stroke (2.34 vs. 2.08 per 1000 person-year, p = 0.26) and CHD (2.39 vs. 2.26, p = 0.53). However, of the women who underwent hysterectomy before 45 years, the hazard ratio of hysterectomy was 2.29 (95% CI, 1.52-3.44) for stroke and 1.14 (95% CI, 0.71-1.83) for CHD.
  
  
  CONCLUSIONS
  Categorized by the patients' age at operation, the associations between hysterectomy and the risk of stroke were different. The excess risk of stroke was observed in women who had hysterectomy before 45 years and remained significant even after accounting for baseline cardiovascular risk factors.
authors.affiliation: Cardiology Division, Internal Medicine Department, Taipei Medical University Wan-Fang Hospital, Taipei, Taiwan; Department of Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: Jong Shiuan
authors.initials: JS
authors.lastname: Yeh
authors.forename: Hao-Min
authors.initials: HM
authors.lastname: Cheng
authors.forename: Pai-Feng
authors.initials: PF
authors.lastname: Hsu
authors.forename: Shih-Hsien
authors.initials: SH
authors.lastname: Sung
authors.forename: Wen-Ling
authors.initials: WL
authors.lastname: Liu
authors.forename: Hsin-Ling
authors.initials: HL
authors.lastname: Fang
authors.forename: Shao-Yuan
authors.initials: SY
authors.lastname: Chuang
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003327:Coronary Disease / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology*; D013624:Taiwan
keywords: Cardiovascular disease; Coronary heart disease; Hysterectomy; Stroke