Decision for hysterectomy as a modifiable cardiovascular risk factor: A systematic review and meta-analysis

Objective: To describe the role of hysterectomy in modifying the major atherosclerotic cardiovascular disease risk factors. Data sources: PubMed, Cochrane Library, Embase, and ScienceDirect were searched from database inception to March 10, 2026. Study eligibility criteria: Full-text randomized controlled trials, case-control studies, cross-sectional studies, cohort studies, case series, and experimental studies reporting new-onset cardiovascular events, diabetes mellitus, hypertension, dyslipidemia, or other metabolic effects following hysterectomy were eligible. Reviews and book chapters were excluded. Study appraisal and synthesis methods: Study selection and data extraction were performed independently by multiple reviewers with conflicts resolved by consensus. Cohort study quality was assessed with the Newcastle-Ottawa Scale; a modified version assessed cross-sectional studies. Meta-analyses were performed using a generic inverse-variance random-effects model for each outcome, stratified by study design (cross-sectional versus cohort) and effect measure (adjusted odds ratio, adjusted hazard ratio, or relative risk). Narrative synthesis was performed for outcomes not meeting criteria for meta-analysis. Results: Twenty studies (11 cohort, 8 cross-sectional, 1 mixed design) were included after screening 18,337 records from four databases. Hysterectomy was associated with significantly increased risk of hypertension (cross-sectional odds ratio 1.32, 95% confidence interval 1.18–1.48; cohort hazard ratio 1.19, 95% confidence interval 1.09–1.30), diabetes (cross-sectional odds ratio 1.21, 95% confidence interval 1.11–1.32; cohort hazard ratio 1.20, 95% confidence interval 1.13–1.29), hyperlipidemia (hazard ratio 1.21, 95% confidence interval 1.13–1.29), obesity (odds ratio 1.24, 95% confidence interval 1.03–1.50), and metabolic syndrome (odds ratio 1.24, 95% confidence interval 1.08–1.44). Conclusions: Hysterectomy is associated with increased risk of hypertension, diabetes, hyperlipidemia, obesity, and metabolic syndrome, key modifiable atherosclerotic cardiovascular disease risk factors. Active cardiovascular risk assessment and follow-up may be warranted for women who undergo hysterectomy, particularly at a young age.