{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T03:30:15Z","timestamp":1790998215388,"version":"4.1.0"},"reference-count":62,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2023,7,1]],"date-time":"2023-07-01T00:00:00Z","timestamp":1688169600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Women's Health"],"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Hysterectomy, oophorectomy, and tubal ligation are common surgical procedures. The literature regarding cardiovascular disease (CVD) risk after these surgeries has focused on oophorectomy with limited research on hysterectomy or tubal ligation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>\n                      Participants in the Nurses' Health Study II (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u2009116,429) were followed from 1989 to 2017. Self-reported gynecologic surgery was categorized as follows: no surgery, hysterectomy alone, hysterectomy with unilateral oophorectomy, and hysterectomy with bilateral oophorectomy. We separately investigated tubal ligation alone. The primary outcome was CVD based on medical-record confirmed fatal and nonfatal myocardial infarction, fatal coronary heart disease, or fatal and nonfatal stroke. Our secondary outcome expanded CVD to include coronary revascularization (coronary artery bypass graft surgery, angioplasty, stent placement). Cox proportional hazard models were used to calculate hazard ratios (HR) and 95% confidence intervals (CIs) and were adjusted\n                      <jats:italic toggle=\"yes\">a priori<\/jats:italic>\n                      for confounding factors. We investigated differences by age at surgery (\u226450, &gt;50) and menopausal hormone therapy usage.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>At baseline, participants were on average, 34 years old. During 2,899,787 person-years, we observed 1,864 cases of CVD. Hysterectomy in combination with any oophorectomy was associated with a greater risk of CVD in multivariable-adjusted models (HR hysterectomy with unilateral oophorectomy:1.40 [95% CI: 1.08\u20131.82]; HR hysterectomy with bilateral oophorectomy:1.27 [1.07\u20131.51]). Hysterectomy alone, hysterectomy with oophorectomy, and tubal ligation were also associated with an increased risk of combined CVD and coronary revascularization (HR hysterectomy alone: 1.19 [95% CI: 1.02\u20131.39]; HR hysterectomy with unilateral oophorectomy: 1.29 [1.01\u20131.64]; HR hysterectomy with bilateral oophorectomy: 1.22 [1.04\u20131.43]; HR tubal ligation: 1.16 [1.06\u20131.28]). The association between hysterectomy\/oophorectomy and CVD and coronary revascularization risk varied by age at gynecologic surgery, with the strongest association among women who had surgery before age 50 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Our findings suggest that hysterectomy, alone or in combination with oophorectomy, as well as tubal ligation, may be associated with an increased risk of CVD and coronary revascularization. These findings extend previous research finding that oophorectomy is associated with CVD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/jwh.2022.0207","type":"journal-article","created":{"date-parts":[[2023,5,8]],"date-time":"2023-05-08T14:58:25Z","timestamp":1683557905000},"page":"747-756","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":15,"title":["Hysterectomy With and Without Oophorectomy, Tubal Ligation, and Risk of Cardiovascular Disease in the Nurses' Health Study II"],"prefix":"10.1177","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7455-8531","authenticated-orcid":false,"given":"Leslie V.","family":"Farland","sequence":"first","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan S.","family":"Rice","sequence":"additional","affiliation":[{"name":"Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"III","given":"William J.","family":"Degnan","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA."},{"name":"Department of Community, Environment, and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn M.","family":"Rexrode","sequence":"additional","affiliation":[{"name":"Divisions of Women's Health and Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JoAnn E.","family":"Manson","sequence":"additional","affiliation":[{"name":"Divisions of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA."},{"name":"Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA."},{"name":"Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric B.","family":"Rimm","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA."},{"name":"Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5066-8808","authenticated-orcid":false,"given":"Janet","family":"Rich-Edwards","sequence":"additional","affiliation":[{"name":"Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA."},{"name":"Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA."},{"name":"Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth A.","family":"Stewart","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Mayo Clinic and Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah L.","family":"Cohen Rassier","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Mayo Clinic and Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Whitney R.","family":"Robinson","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacey A.","family":"Missmer","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA."},{"name":"Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2023,7,13]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2020.05.012"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e318299a6cf"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000285997.38553.4b"},{"key":"e_1_3_6_5_2","volume-title":"Current Contraceptive Status Among Women Aged 15\u201349: United States, 2017\u20132019","author":"Daniels KAJ.","unstructured":"Daniels KAJ. Current Contraceptive Status Among Women Aged 15\u201349: United States, 2017\u20132019. Hyattsville, MD: National Institute for Health Statistics; 2020."},{"key":"e_1_3_6_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3181a11c64"},{"key":"e_1_3_6_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000159344.21672.FD"},{"key":"e_1_3_6_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-2667(19)30155-0"},{"key":"e_1_3_6_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/gme.0b013e31818888f7"},{"key":"e_1_3_6_10_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2011.121"},{"key":"e_1_3_6_11_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j372"},{"key":"e_1_3_6_12_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehq477"},{"key":"e_1_3_6_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/GME.0000000000001043"},{"key":"e_1_3_6_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2013.03.042"},{"key":"e_1_3_6_15_2","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000010421"},{"key":"e_1_3_6_16_2","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.15389"},{"key":"e_1_3_6_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2020.04.037"},{"key":"e_1_3_6_18_2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3182864350"},{"key":"e_1_3_6_19_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.gme.0000218683.97338.ea"},{"key":"e_1_3_6_20_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2016.2415"},{"key":"e_1_3_6_21_2","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/deaa124"},{"key":"e_1_3_6_22_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2005.00696.x"},{"key":"e_1_3_6_23_2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000001398"},{"key":"e_1_3_6_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmig.2015.01.025"},{"key":"e_1_3_6_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.04.042"},{"key":"e_1_3_6_26_2","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwx023"},{"key":"e_1_3_6_27_2","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/deaa051"},{"key":"e_1_3_6_28_2","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/deaa064"},{"issue":"12","key":"e_1_3_6_29_2","first-page":"991","article-title":"Is surgical menopause associated with future levels of cardiovascular risk factor independent of antecedent levels? The CARDIA study","volume":"182","author":"Appiah D","year":"2015","unstructured":"Appiah D, , Schreiner PJ, , Bower JK, et al. Is surgical menopause associated with future levels of cardiovascular risk factor independent of antecedent levels? The CARDIA study. Am J Epidemiol, 2015; 182(12):991\u2013999.","journal-title":"Am J Epidemiol"},{"key":"e_1_3_6_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.maturitas.2021.06.001"},{"key":"e_1_3_6_31_2","doi-asserted-by":"publisher","DOI":"10.1093\/ajh\/hpu183"},{"key":"e_1_3_6_32_2","doi-asserted-by":"publisher","DOI":"10.1111\/jch.13253"},{"key":"e_1_3_6_33_2","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2016.303350"},{"key":"e_1_3_6_34_2","volume-title":"Cardiovascular Survey Methods","author":"Rose GA BH","year":"1982","unstructured":"Rose GA BH. Cardiovascular Survey Methods, 2nd ed. Geneva: World Health Organization; 1982; (WHO monograph series No 58.)."},{"issue":"2","key":"e_1_3_6_35_2","first-page":"I13","article-title":"The National Survey of Stroke. Clinical findings","volume":"12","author":"Walker AE","year":"1981","unstructured":"Walker AE, , Robins M, , Weinfeld FD. The National Survey of Stroke. Clinical findings. Stroke, 1981; 12(2 Pt 2 Suppl 1):I13\u2013I44.","journal-title":"Stroke"},{"key":"e_1_3_6_36_2","doi-asserted-by":"publisher","DOI":"10.1097\/GME.0000000000000506"},{"key":"e_1_3_6_37_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajpc.2020.100131"},{"key":"e_1_3_6_38_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-017-2471-1"},{"issue":"5","key":"e_1_3_6_39_2","first-page":"757","article-title":"Hysterectomy and race","volume":"82","author":"Kjerulff KH","year":"1993","unstructured":"Kjerulff KH, , Guzinski GM, , Langenberg PW, et al. Hysterectomy and race. Obstet Gynecol, 1993; 82(5):757\u2013764.","journal-title":"Obstet Gynecol"},{"key":"e_1_3_6_40_2","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.83.1.106"},{"key":"e_1_3_6_41_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2017.07.036"},{"issue":"9","key":"e_1_3_6_42_2","first-page":"553","article-title":"Socioeconomic indicators and hysterectomy status in the United States, 2004","volume":"54","author":"Erekson EA","year":"2009","unstructured":"Erekson EA, , Weitzen S, , Sung VW, et al. Socioeconomic indicators and hysterectomy status in the United States, 2004. J Reprod Med, 2009; 54(9):553\u2013558.","journal-title":"J Reprod Med"},{"key":"e_1_3_6_43_2","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.13633"},{"key":"e_1_3_6_44_2","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0000000000001171"},{"key":"e_1_3_6_45_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-018-31347-z"},{"key":"e_1_3_6_46_2","doi-asserted-by":"publisher","DOI":"10.1097\/gme.0b013e31825040f9"},{"key":"e_1_3_6_47_2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e318236fd12"},{"key":"e_1_3_6_48_2","doi-asserted-by":"publisher","DOI":"10.3109\/09513590.2013.788633"},{"key":"e_1_3_6_49_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0015-0282(16)45858-9"},{"key":"e_1_3_6_50_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0412.2011.01114.x"},{"key":"e_1_3_6_51_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF02340184"},{"key":"e_1_3_6_52_2","doi-asserted-by":"publisher","DOI":"10.1016\/0010-7824(92)90109-7"},{"key":"e_1_3_6_53_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2005.12.002"},{"key":"e_1_3_6_54_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.atherosclerosis.2011.01.053"},{"key":"e_1_3_6_55_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2007-1738"},{"key":"e_1_3_6_56_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.88.5.2163"},{"key":"e_1_3_6_57_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.ATV.17.4.695"},{"key":"e_1_3_6_58_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2004-0744"},{"issue":"4","key":"e_1_3_6_59_2","first-page":"249","article-title":"Estradiol\/testosterone imbalance: Impact on coronary heart disease risk factors in postmenopausal women","volume":"121","author":"Dai W","year":"2012","unstructured":"Dai W, , Li Y, , Zheng H. Estradiol\/testosterone imbalance: Impact on coronary heart disease risk factors in postmenopausal women. Cardiol, 2012; 121(4):249\u2013254.","journal-title":"Cardiol"},{"key":"e_1_3_6_60_2","doi-asserted-by":"publisher","DOI":"10.1007\/s13669-020-00287-9"},{"key":"e_1_3_6_61_2","first-page":"101161strokeaha","article-title":"Laparoscopically confirmed endometriosis and risk of incident stroke: A prospective cohort study","author":"Farland LV","year":"2022","unstructured":"Farland LV, , Degnan WJ, , 3rd, Bell ML, et al. Laparoscopically confirmed endometriosis and risk of incident stroke: A prospective cohort study. Stroke, 2022:101161strokeaha122039250","journal-title":"Stroke"},{"key":"e_1_3_6_62_2","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.117.09056"},{"key":"e_1_3_6_63_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2021-067528"}],"container-title":["Journal of Women's Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1089\/jwh.2022.0207","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/jwh.2022.0207","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/jwh.2022.0207","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T11:16:31Z","timestamp":1779102991000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1089\/jwh.2022.0207"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7]]},"references-count":62,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2023,7]]}},"alternative-id":["10.1089\/jwh.2022.0207"],"URL":"https:\/\/doi.org\/10.1089\/jwh.2022.0207","relation":{},"ISSN":["1540-9996","1931-843X"],"issn-type":[{"value":"1540-9996","type":"print"},{"value":"1931-843X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7]]}}}