BackgroundThe associations between hysterectomy and cardiovascular disease (CVD) and mortality remains unlcear and a meta‐analysis with cohort studies is lacking.ObjectivesThis study aimed to conduct a systematic review and meta‐analysis of cohort studies to investigate the relationship between hysterectomy and CVD, coronary heart disease (CHD), stroke, heart failure, and all‐cause, cardiovascular and cancer mortality. We further explored the effect of oophorectomy on the association between hysterectomy and these health outcomes.Search strategyPubMed, EMBASE and Web of Science were searched up to 24 July 2023.Selection criteriaCohort studies.Data collection and analysisHazard ratios (HRs) and 95% confidence intervals (95% CIs) were pooled using a random‐effects model. We used I2 to assess the heterogeneity between studies.Main resultsForty‐three studies were included in the meta‐analysis. Hysterectomy was significantly associated with an increased risk of CVD (pooled HR 1.11, 95% CI 1.09–1.13; n = 6; I2 = 0) and stroke (HR 1.09, 95% CI 1.04–1.14; n = 7; I2 = 52%), but with a decreased risk of cancer mortality (HR 0.93, 95% CI 0.86–1.00; n = 4; I2 = 81%). No significant association was observed between hysterectomy and CHD (n = 10; I2 = 83%), all‐cause mortality (n = 8; I2 = 81%) or cardiovascular mortality (n = 7; I2 = 89%). Hysterectomy with and without oophorectomy was significantly associated with CVD and stroke risk, but showed a larger effect size for hysterectomy with oophorectomy. A significantly increased risk of CHD was observed in the subgroup of hysterectomy with oophorectomy, but not for the subgroup of hysterectomy alone.ConclusionsHysterectomy may increase the risk of CVD, CHD and stroke, but not all‐cause, cardiovascular or cancer mortality. Hysterectomy with oophorectomy may have a higher risk of CVD, CHD and stroke than hysterectomy alone. However, the results on CHD and mortality related to hysterectomy should be interpreted cautiously because of the high level of heterogeneity and unstable subgroup analyses.

中文翻译：

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检查子宫切除术联合或不联合卵巢切除术与心血管疾病和全因、心血管或癌症死亡率的关系：系统评价和荟萃分析


背景子宫切除术与心血管疾病（CVD）和死亡率之间的关系仍不清楚，并且缺乏队列研究的荟萃分析。目的本研究旨在对队列研究进行系统回顾和荟萃分析，以探讨子宫切除术与心血管疾病、冠状动脉疾病之间的关系。心脏病 (CHD)、中风、心力衰竭以及全因、心血管和癌症死亡率。我们进一步探讨了卵巢切除术对子宫切除术与这些健康结果之间关系的影响。搜索策略 PubMed、EMBASE 和 Web of Science 的搜索截止日期为 2023 年 7 月 24 日。选择标准队列研究。数据收集和分析风险比 (HR) 和 95% 置信区间（95% CI）使用随机效应模型进行汇总。我们使用 I2 来评估研究之间的异质性。主要结果 43 项研究纳入荟萃分析。子宫切除术与 CVD（汇总 HR 1.11，95% CI 1.09–1.13；n = 6；I2 = 0）和中风（HR 1.09，95% CI 1.04–1.14；n = 7；I2 = 52）风险增加显着相关%），但癌症死亡风险降低（HR 0.93，95% CI 0.86–1.00；n = 4；I2 = 81%）。子宫切除术与冠心病（n = 10；I2 = 83%）、全因死亡率（n = 8；I2 = 81%）或心血管死亡率（n = 7；I2 = 89%）之间没有观察到显着关联。子宫切除术联合或不联合卵巢切除术与心血管疾病和中风风险显着相关，但子宫切除术联合卵巢切除术的效应更大。在子宫切除术联合卵巢切除术的亚组中观察到 CHD 的风险显着增加，但在单独子宫切除术的亚组中则没有。结论子宫切除术可能会增加 CVD、CHD 和中风的风险，但不会增加全因死亡率、心血管死亡率或癌症死亡率。 与单纯子宫切除术相比，子宫切除术联合卵巢切除术可能会增加心血管疾病、冠心病和中风的风险。然而，由于高度异质性和不稳定的亚组分析，应谨慎解释与子宫切除术相关的冠心病和死亡率的结果。