Cardiovascular disease: Gynecological surgery tied to higher risk

• Hysterectomies with or without oophorectomies and tubal ligations are surgeries that are sometimes pursued electively. Other times, they are medically necessary.
• Researchers are still seeking to understand the full risks of these procedures to provide the most accurate information.
• A​ recent study found that women who undergo hysterectomies, oophorectomies, or tubal ligations are at an increased risk for cardiovascular disease.
• The risk may be most significant for women under 50 years of age who undergo hysterectomies and oophorectomies.

Any surgical procedure comes with certain risks and benefits. People and their doctors must weigh the benefits against the risks to decide how to proceed.

There are several indicators for removing the uterus with or without the removal of the ovaries. Another common procedure is tubal ligation, which is when doctors cut the fallopian tubes to prevent pregnancy permanently.

Researchers are still working to understand the risks associated with these procedures. A recent study published in the Journal of Women’s Health examined the relationship between these procedures and cardiovascular disease.

The study authors found that women undergoing these procedures had an increased risk of developing cardiovascular disease.

Hysterectomies and tubal ligation

A​ hysterectomy is when doctors remove the uterus. A hysterectomy may or may not also include the removal of the cervix. Doctors may recommend hysterectomies for many reasons, such as cancer, abnormal vaginal bleeding, or endometriosis. Hysterectomies are also a method of sterilization.

Sometimes along with a hysterectomy, a surgeon may also perform an oophorectomy, which is the removal of the ovaries. An oophorectomy may or may not include the removal of the fallopian tubes. If it does, the procedure is called salpingo-oophorectomy.

A​ tubal ligation involves a severing of the fallopian tubes. This procedure can also be a method of sterilization to prevent pregnancy.

Each of these procedures presents unique risks and potential benefits. Obstetrics and gynecology specialist Dr. Faina Gelman-Nisanov, not involved in the current research, offered further insight into these procedures to Medical News Today:

“The risks of all surgical procedures are unique to the patient’s personal medical and surgical history. A broad list of risks [includes] bleeding, pain, infection, and damage to nearby organs[…] Current practices for recommendation of such procedures include a thorough understanding of the patient, the acuteness of the clinical situation, surgical indications, patient’s medications, patient’s medical and surgical history, and a thorough counseling of patient’s expectations and outcomes post-surgery.”

Hysterectomy and cardiovascular disease

The researchers who conducted the current study used data from participants in the Nurses’ Health Study II, including over 116,000 participants in their analysis. They gathered data on the following surgical procedures among participants:

• hysterectomy only
• hysterectomy with removal of one ovary
• hysterectomy with removal of both ovaries
• tubal ligation.

Researchers also noted which participants had not undergone any of these procedures. They then looked at the incidence of certain cardiovascular events.

They looked at which participants experienced fatal and non-fatal heart attacks and strokes and the incidence of fatal coronary heart disease. They also looked at the number of participants that underwent coronary revascularization, which includes procedures that improve blood flow to the heart, like coronary artery bypass graft surgery.

Researchers found that women who had undergone hysterectomies with or without ovary removal and those who had undergone tubal ligation were at an increased risk for cardiovascular disease and coronary revascularization.

Overall, the associated risk for cardiovascular disease was greatest among participants under fifty who underwent hysterectomy with ovary removal.

Study author Dr. JoAnn E. Manson, chief of the Division of Preventive Medicine of the Brigham and Women’s Hospital, noted some of the study’s key findings to MNT.

“The key goals were to understand whether common gynecologic surgeries are associated with increased risk of cardiovascular disease among women in early-to-middle adulthood,” she told us.

“We found that all of these gynecologic surgeries were linked to small-to-moderate increases in the risk of [cardiovascular disease] events. The strongest associations were seen in women who had surgery before age 50,” Dr. Manson said.

The study results further indicate that discussing cardiovascular disease could become important when people consider these surgeries.

Study author Dr. Leslie Farland, assistant professor with the Department of Epidemiology and Biostatistics at Mel and Enid Zuckerman College of Public Health, University of Arizona, explained to MNT that “[t]his research builds on prior research that suggests that gynecologic surgery may influence cardiovascular disease risk.”

“Importantly, gynecologic surgeries may serve an important purpose in treating medical conditions. Therefore, clinicians should consider incorporating a discussion of cardiovascular disease risk when counseling patients about the use of gynecologic surgery and tubal ligation,” she added.

‘Further research is needed’

The study provided unique insights into some of the risks associated with hysterectomy procedures. However, the study also had notable limitations. First, this data cannot prove that any of the procedures studied cause cardiovascular disease.

Researchers were limited by the age of participants and the amount of follow-up time. When the follow-up ended, women were between 53 and 70 years old. This age range may be relatively young for the development of cardiovascular events.

T​he researchers also did not have information on why participants underwent these procedures. So, the associated risks for cardiovascular disease may also be related to the reasons for procedures, which may include gynecologic conditions, such as endometriosis, fibroids, and adenomyosis.

Based on the timing of the study, it may not fully represent the surgical techniques for these procedures that surgeons use today. There is still the risk of residual confounding or the influence of other factors on the results.

Most participants were white, which offers limited information and the need for greater diversity in later studies. Finally, some of the data collected relied on self-reporting, which introduces the risks of certain errors.

Overall, the study highlights the importance of careful discussion and research before undergoing these surgical procedures. Dr. Farland, noted areas of continued study to MNT.

“Further research is needed to understand the influence of cardiovascular disease risk factors prior to surgery on these observed associations,” she told us. “Additionally, future research is needed to understand the mechanisms underlying the associations between gynecologic surgery and cardiovascular risk and the risks and benefits associated with these procedures to better counsel patients.”

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