Meta-analysisindependent cross-checkabstract checked★ key study I-ORG-136 in-depth review
Hysterectomy and heart disease: pooled cohort studies
Examining the association of hysterectomy with and without oophorectomy on cardiovascular disease and all-cause, cardiovascular or cancer mortality: A systematic review and meta-analysis.
Overview
Chen Y et al.. BJOG 2024 · PMID 38747094 · DOI 10.1111/1471-0528.17843
Hysterectomy was linked to about 10% more cardiovascular disease and stroke, but not to more deaths.
Does the study support the specific claim? Partly · Methodological quality: moderate
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Pool cohort studies on hysterectomy and heart outcomes
- How was the study done?
Meta-analysis
- How many people, animals or samples were studied?
43 studies
- What was actually found?
CVD HR 1.11; no mortality increase
- How large was the observed effect?
HR 1.11 (1.09-1.13)
- What do the results mean in everyday life?
A small possible risk to discuss before elective hysterectomy
- What are the study's limitations?
Heterogeneity, confounding
- What does it say about Elawady's specific claim?
Partly supports the claim; contradicts 'harms the heart' as a strong statement
- Do the results apply to Germany and Europe?
Applicable
- What can explicitly not be concluded from this study?
Cannot prove causation
Scientific in-depth review
1. Full reference
- Authors
- Chen Y et al.
- Journal
- BJOG
- Year
- 2024
- Identifier
- PMID 38747094 DOI 10.1111/1471-0528.17843
- Verification
- verified – PubMed efetch 2026-10-26; Crossref works API 2026-10-26
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
Not stated in abstract.
2. Research question
Association of hysterectomy (with/without oophorectomy) with CVD and mortality.
3. Study design and population
- Study design
- Meta-analysis – Systematic review and meta-analysis of cohort studies
- Population
Women in cohort studies
- Country
Multinational
- Period
Search to 24 July 2023
- Sample size
43 studies
- Inclusion and exclusion criteria
Cohort studies
4. Methods and endpoints
- Exposure / intervention
Hysterectomy +/- oophorectomy
- Comparator
No hysterectomy
- Endpoints
CVD, CHD, stroke, heart failure, all-cause/CV/cancer mortality
- Statistical methods
Random-effects pooled HR; I2
5. Actual results
- Results
Hysterectomy: CVD HR 1.11 (1.09-1.13; n = 6; I2 0); stroke 1.09 (1.04-1.14; I2 52%); cancer mortality 0.93 (0.86-1.00). No significant association with CHD (I2 83%), all-cause mortality (I2 81%) or CV mortality (I2 89%). Larger effects with oophorectomy; CHD increased only in the hysterectomy-with-oophorectomy subgroup.
- Absolute risks
Not reported
- Authors' conclusion
Hysterectomy may increase CVD, CHD and stroke risk but not mortality; oophorectomy adds risk; interpret CHD and mortality cautiously due to heterogeneity.
6. Strengths
- Many cohorts
- Separate analysis by oophorectomy
7. Weaknesses
- High heterogeneity for several outcomes
- Observational confounding
8. Risk of bias
- Orienting tool
- AMSTAR 2
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
- Rationale
Cohort-based pooling.
9. Assessment of the statistical interpretation
Modest relative effects (about 10%); absolute differences not reported.
10. Relevance to the specific claim
Best pooled evidence on hysterectomy and heart outcomes.
11. Independent contrary findings
Iversen 2005 (A-ORG-12): no mortality increase.
12. Transferability to Germany and Europe
Includes European cohorts.
13. Overall methodological judgement
Supports a modest CVD/stroke association (about 10%) without mortality increase; with ovaries conserved, CHD not increased.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | moderate |
| Risk of bias | some concerns |
| Precision of results | high |
| Directness | direct |
| Reproducibility | replicated |
| Consistency with the overall evidence | mixed |
| Regional transferability | high |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
Mechanism for hysterectomy alone.
15. Linked fact checks
- Hysterectomy (even with ovaries conserved) harms the heart and metabolism; uterus and ovaries form a hormonal network protecting heart, brain and bone. – Studies with mixed or unclear results