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Study Unravels Hysterectomy-Heart Disease Link

Operation itself does not raise a woman's cardiovascular risk, study finds

MONDAY, March 21, 2005 (HealthDay News) -- A woman who has a hysterectomy is more vulnerable to heart disease, stroke and other cardiovascular problems, a new study finds -- but the hysterectomy is not to blame.

Instead, say researchers reporting in the March 22 issue of Circulation, women who have hysterectomies are also more likely to have the classic risk factors for cardiovascular trouble such as obesity, high blood pressure, high cholesterol, diabetes and smoking.

"We found that they had higher levels of most risk factors than women who did not have hysterectomies, [but] if you adjust for those risk factors, there is no increased risk associated with a hysterectomy," said lead researcher Barbara V. Howard, president of the MedStar Research Institute, in Baltimore.

"We started this study because of our knowledge about hormone levels influencing cardiovascular risk," Howard explained, so "it was conceivable that having a hysterectomy put a woman at higher risk."

The MedStar Research Institute is part of the largest health-care group in the mid-Atlantic states, operating seven academic medical centers in the Washington-Baltimore area. Howard and her colleagues are also investigators for the Women's Health Initiative, which is following more than 93,000 postmenopausal women to learn more about the incidence and causes of chronic diseases in women as they age.

According to the study, more than 41 percent of the women had undergone hysterectomies. The overall risk for cardiovascular disease in women with a history of this type of surgery was 26 percent higher than for women who had never had their uterus removed.

However, Howard's team also found that women with hysterectomies tended to be more obese and to suffer from diabetes, high blood pressure and high cholesterol. They also exercised less and consumed more saturated fat.

There's a strong socioeconomic influence on the prevalence of all of those cardiovascular disease risk factors, Howard added. Women who had hysterectomies tended to be in lower-income groups and black women, native Americans and Hispanic women were more likely to have had the surgery than whites.

Studies have shown that lower-income women often don't have access to the kind of health care needed to identify and correct the presence of cardiovascular risk factors, Howard said.

Health-care providers "should be aware that hysterectomized women are at higher risk and should pay close attention to blood pressure smoking, cholesterol and other risk factors," she said.

There has been an ongoing debate about the role of hysterectomy in cardiovascular disease, said Kate M. Brett, a research epidemiologist with the U.S. Centers for Disease Control and Prevention, who wrote an accompanying editorial.

"A lot of research has been done," she said. "I felt we have looked at it as long as we can. We can now put the question to rest. Hysterectomy is not causal for cardiovascular disease. They just happen to be associated."

Hysterectomy could also be a marker of risk for other medical problems, again because of socioeconomic factors, Brett said. "These women might not get the same kind of treatment for gynecological conditions as other women," she noted.

More information

Factors that do influence a woman's risk of cardiovascular disease are listed by the American Heart Association.

SOURCES: Barbara V. Howard, Ph.D, president, MedStar Research Institute, Baltimore; Kate M. Brett, Ph.D, research epidemiologist, U.S. Centers for Disease Control and Prevention, Atlanta; March 22, 2005, Circulation
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