walkitout (walkitout) wrote,
walkitout
walkitout

hysterectomies and heart disease

A friend, K., sent me an e-mail with this link, suggesting it might fit in well with the kind of ranting I am wont to do (not her words):

http://www.truthout.org/021609R

I had not previously encountered this particular connection between hysterectomy and heart disease, so I thought I'd do a little googling. After all, those are some old studies -- what are the new studies saying?

Back in 2005,

http://www.emaxhealth.com/4/2263.html

This AHA Circulation article described a largish (90K women) study. They found that women who had hysterectomies did have a higher risk of having a cardiovascular event (and when it comes to your heart and circulatory system, you don't want events. Events are bad.). They also found that women who had hysterectomies also hypertension, higher cholesterol and diabetes at higher rates, and higher white blood cell counts indicating (chronic) inflammation. They exercised less, ate more saturated fat, had larger waists and were more likely to be obese. After doing all their math, they concluded there was some leftover risk, but not statistically significant. They think the whole thing comes down to socioeconomic class, even tho their study wasn't design to ferret how the why.

I find this explanation actually somewhat unsatisfying. If the hysterectomy/heart disease thing works the way the folk over at Truthout think it works, then hypertension, diabetes and high cholesterol would _also_ be (at least partly) attributable to the hysterectomy (also, for that matter, the obesity, larger waist, etc.).

ETA: Here's the study that secondary coverage is referring to (available full text for free):

http://www.circ.ahajournals.org/cgi/content/full/111/12/1456

I actually find it even less compelling in detail. They're really trying to shut down this theory, and are willing to toss the whole iron stores question along with it, in hopes that because we don't believe the iron thing, we won't believe the hysterectomy thing. Ha! I _do_ believe the iron thing.

Here's an earlier study attempting to answer the same question back in the Bad Old Days when we thought HRT might help:

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1380855

Here's a meta-study done to try to figure out what the tradeoff was between ovarian cancer risks, removing the ovaries with a hysterectomy vs. oh go read it yourself.

http://www.anapsid.org/cnd/hormones/hysterectomy.html

This is actually kind of cool, but definitely fails to address the socioeconomic issue raised by the idiots in the first study I found out about. The nicest thing about this study is that it shows someone thinking about the fact that more women are going to die of heart disease than ovarian cancer, so doing something to reduce the risk of dying of ovarian cancer that elevates their risk of dying of heart disease is probably a bad idea.

ETA: So what do I conclude from all of this?

First, and very predictably, I'm going to conclude once again that if you can avoid a medical procedure, it's probably a good idea to do so. If you have to have something done, proceed as conservatively as possible -- which is to say, remove as little as you can get away with. There are no "optional" organs, altho there are quite a few you can live without, just like you can live without your arms, your legs, your genitals, your nose, your collar bone -- but who would want to if they didn't have to? And it's mean to try to convince people that something is "optional" and they would therefore be better off without it. Once again, doctors come off looking bad, particularly in the South, and particularly when they are treating people with limited resources and choices.

Second, I think there's a whole lot we do not understand about women's reproductive system, and all the things their "reproductive" system does other than reproduce. OTOH, if you want to avoid a heart attack, I think it's probably better to worry first about diet and exercise, and later about things like hysterectomies. Just looking at the scale of the problem, anyway.
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