Improved Cardiometabolic Health with Uterine-Preserving Fibroid Treatment Compared to Hysterectomy

TL;DR

Hysterectomy for uterine fibroids is linked to worse heart and metabolic health compared to other treatments or no surgery.

Contribution

This study shows that hysterectomy increases cardiometabolic risks compared to myomectomy or no surgery.

Findings

Hysterectomy was associated with higher odds of stroke, hypertension, hyperlipidemia, and type II diabetes compared to no surgery.

Hysterectomy had higher odds of hyperlipidemia compared to myomectomy.

Ovary removal during hysterectomy did not improve cardiometabolic outcomes.

Abstract

Background/Objectives: Over 600,000 hysterectomies are performed in the United States annually, with uterine fibroids being the most common indication. It remains unknown whether removal of the uterus is associated with poor cardiometabolic outcomes. This study aimed to determine whether hysterectomy is associated with adverse cardiometabolic outcomes among patients with uterine fibroids (myomectomy and no surgery as controls). Methods: Retrospective cohort study utilizing MarketScan® Database of U.S. healthcare claims dataset, including patients aged 18–55 with uterine fibroid diagnosis in 2010 or 2011 and 10 years of continuous enrollment. Patients were stratified into three groups: hysterectomy, myomectomy, and no surgery. Patients were then followed for 10 years to determine incidence of cardiometabolic disorders. The main outcome measures included coronary artery disease, congestive heart failure, cardiac arrhythmia, stroke, hypertension, hyperlipidemia, type II diabetes, and peripheral artery disease, which were defined using the ICD-9, ICD-10, and CPT codes. Results: 34,722 participants with uterine fibroids were identified. Among these, 8,196 (23.61%) patients underwent hysterectomy, 1351 patients (3.89%) underwent myomectomy, and 25,175 (72.50%) patients did not undergo surgery. Hysterectomy was associated with higher age-adjusted odds of developing stroke (aOR = 1.11), hypertension (aOR = 1.14), hyperlipidemia (aOR = 1.14), and type II diabetes (aOR = 1.20) compared to no surgery. Hysterectomy was associated with higher age-adjusted odds of developing hyperlipidemia (aOR = 1.26) compared to myomectomy. Hysterectomy with removal of ovaries versus hysterectomy with retention of ovaries had similar cardiometabolic outcomes. Conclusions: Among patients with fibroids, hysterectomy was associated with higher odds of developing adverse cardiometabolic outcomes compared to myomectomy or no surgery. Retention of the ovaries was not protective among those undergoing hysterectomy.

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