Cardiovascular outcomes after hysterectomy: a systematic review and meta-analysis

Abstract

Background: Hysterectomy is a common nonobstetric surgical procedure performed in women. However, the cardiovascular effects of hysterectomy remain unclear. This meta-analysis compared cardiovascular outcomes in women with and without a history of hysterectomy. Methods: A comprehensive search of four databases was conducted from inception to March 25, 2025. Studies were included if they reported cardiovascular outcomes in women with versus without hysterectomy. Results: A total of 28 studies involving 2,942,404 participants were included in this meta-analysis. Cardiovascular disease occurred more frequently among women undergoing hysterectomy than among those without hysterectomy (pooled hazard ratio [HR], 1.19; 95% confidence interval [CI], 1.09–1.29; P < 0.01). A higher incidence of stroke was observed in women with hysterectomy (pooled HR 1.11, 95% CI 1.01–1.22, P = 0.03). The association between hysterectomy and cardiovascular outcomes differed by timing of surgery. An increased risk of stroke, coronary artery disease, and cardiovascular disease was identified following premenopausal hysterectomy. In contrast, no significant association with cardiovascular events was found for postmenopausal procedures. Additionally, a higher occurrence of stroke, myocardial infarction, and cardiovascular disease was observed in women undergoing hysterectomy with bilateral oophorectomy. Conclusions: Cardiovascular events occurred more frequently following hysterectomy, particularly among women before menopause. Cardiovascular risk assessment may be warranted in this population.