Abstract Body (Do not enter title and authors here): Background: Hysterectomy is one of the most commonly performed non-obstetric surgical procedures in women globally. However, the long-term cardiovascular effects of hysterectomy remain unclear. This systematic review and meta-analysis aimed to evaluate the impact of hysterectomy on cardiovascular outcomes.
Methods: A systematic search was conducted across 4 databases, including PubMed, Embase, Web of Science, and Cochrane CENTRAL, from inception to March 25, 2025, without language restrictions. Studies were included if they compared cardiovascular outcomes between women who underwent hysterectomy versus non-hysterectomy. A random-effects model was used for meta-analysis.
Results: A total of 28 studies involving 2,942,404 participants were included. Hysterectomy was associated with a higher risk of cardiovascular disease compared to no hysterectomy (pooled hazard ratio (HR) 1.19, 95%CI 1.09-1.29, p<0.01). When stratified by age at surgery, hysterectomy performed at a premenopausal age was associated with a higher risk of cardiovascular disease compared to no hysterectomy (pooled HR 1.16, 95%CI 1.09-1.23, p<0.01). In contrast, hysterectomy performed at a postmenopausal age was not significantly associated with an increased risk of cardiovascular disease compared to no hysterectomy (pooled HR 1.04, 95%CI 0.97-1.12, p=0.27). Hysterectomy was also associated with an increased risk of stroke (pooled HR 1.11, 95%CI 1.01-1.22, p=0.03). However, hysterectomywas not associated with an increased risk of cardiovascular mortality compared to no hysterectomy (pooled HR 0.77, 95%CI 0.59-1.02, p=0.07).
Conclusions: Hysterectomy is associated with an increased risk of cardiovascular events, particularly when performed at a premenopausal age. These findings highlight the importance of cardiovascular risk assessment and surveillance in women undergoing hysterectomy.