Can J Cardiol. 2026 Jun 12:S0828-282X(26)00525-8. doi: 10.1016/j.cjca.2026.06.003. Online ahead of print.
ABSTRACT
BACKGROUND: Hysterectomy is the most frequently performed surgery in non-pregnant females yet may have under-appreciated implications for long-term chronic disease risk. This study investigated the association between benign hysterectomy with ovarian conservation and future risk of cardiometabolic disease.
METHODS: This was a population-based cohort study of females aged 20-39 years in Alberta (1997-2021) and included: (i) an overall cohort with all eligible females (n=1,191,263); and (ii) a matched sub-cohort of exposed females (n=45,331) age-matched with 6 unexposed females (n=271,986). The primary outcome was first diagnosis of cardiometabolic disease and secondary outcomes were 10 cardiometabolic diseases. We used Cox proportional hazards regression modelling with age as the time scale (median follow-up 13.3 years) in the overall cohort; and Royston-Parmar models with time since surgery as the time scale (median follow-up 10.3 years) in the age-matched sub-cohort. Models were adjusted for birth year or year of hysterectomy, and time-varying rural residence, material deprivation quintile, continuity of primary care, and comorbidities.
RESULTS: In the overall cohort, hysterectomy was associated with accelerated time to first diagnosis of cardiometabolic disease (aHR 1.33, 95% CI 1.30 to 1.36) and with incidence of 7/10 cardiometabolic diseases; the strongest associations were chronic kidney disease (1.29, 1.23 to 1.35), ischemic heart disease (1.31, 1.25 to 1.38), metabolic dysfunction-associated steatotic liver disease (1.43, 1.32 to 1.55), and stroke (1.33, 1.23 to 1.45). Results were similar in the age-matched sub-cohort.
CONCLUSION: Benign hysterectomy with ovarian conservation may be an important female-specific risk factor for cardiometabolic disease, warranting judicious use and expanded patient counselling on potential long-term health risks.
PMID:42285253 | DOI:10.1016/j.cjca.2026.06.003