Cohort studyindependent cross-checkabstract checked I-ORG-137 standard review
Hysterectomy before 50 and heart disease in Korea
Association of Early Hysterectomy With Risk of Cardiovascular Disease in Korean Women.
Overview
Yuk JS et al.. JAMA Netw Open 2023 · PMID 37307002 · DOI 10.1001/jamanetworkopen.2023.17145
Women who had a hysterectomy in their 40s had about 25% more cardiovascular events, mostly strokes, but the absolute increase was small.
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?
Study CVD risk after early hysterectomy
- How was the study done?
Matched national cohort
- How many people, animals or samples were studied?
55,539 pairs
- What was actually found?
More CVD, especially stroke
- How large was the observed effect?
HR 1.25; 115 vs 96 per 100,000 PY
- What do the results mean in everyday life?
Small extra risk to weigh in elective surgery
- What are the study's limitations?
Claims data
- What does it say about Elawady's specific claim?
Supports a modest part of the claim
- Do the results apply to Germany and Europe?
Moderate
- What can explicitly not be concluded from this study?
Cannot prove causation
Scientific in-depth review
1. Full reference
- Authors
- Yuk JS et al.
- Journal
- JAMA Netw Open
- Year
- 2023
- Identifier
- PMID 37307002 DOI 10.1001/jamanetworkopen.2023.17145
- 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
Non-commercial support (PubMed).
2. Research question
Is hysterectomy before age 50 associated with incident CVD?
3. Study design and population
- Study design
- Cohort study – Population-based cohort with propensity-score matching (Korean NHIS)
- Population
Korean women aged 40-49
- Country
South Korea
- Period
2011-2014, follow-up to 2020 (median 7.9 years)
- Sample size
55,539 matched pairs (from 135,575)
- Inclusion and exclusion criteria
Women 40-49
4. Methods and endpoints
- Exposure / intervention
Hysterectomy
- Comparator
No hysterectomy (matched incl. adnexal surgery, comorbidities, MHT)
- Endpoints
Composite CVD (MI, coronary revascularisation, stroke)
- Statistical methods
Cox HR
5. Actual results
- Results
CVD 115 vs 96 per 100,000 person-years; HR 1.25 (1.09-1.44). Stroke HR 1.31 (1.12-1.53); MI and revascularisation comparable. Excluding oophorectomy: HR 1.24 (1.06-1.44).
- Absolute risks
19 extra CVD events per 100,000 person-years.
- Authors' conclusion
Early hysterectomy was associated with increased CVD, particularly stroke.
6. Strengths
- Large matched cohort
- Analysis excluding oophorectomy
7. Weaknesses
- Claims data
- Residual confounding (reasons for hysterectomy)
8. Risk of bias
- Orienting tool
- ROBINS-E
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
- Rationale
Propensity matching; indication confounding possible.
9. Assessment of the statistical interpretation
Absolute excess about 1 event per 5300 woman-years (stats/C-ORG-09_10_11_gyn.py).
10. Relevance to the specific claim
Supports a CVD association even with ovaries conserved in younger women.
11. Independent contrary findings
No CHD increase in this study; mortality not studied.
12. Transferability to Germany and Europe
Korean; broadly transferable.
13. Overall methodological judgement
Supports a modest stroke/CVD association after hysterectomy before 50; absolute risk small.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | moderate |
| Risk of bias | some concerns |
| Precision of results | moderate |
| Directness | direct |
| Reproducibility | replicated |
| Consistency with the overall evidence | consistent |
| Regional transferability | moderate |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
Mechanism.