Women with endometriosis have a greater risk for angina, myocardial infarction, or the need for coronary artery bypass graft surgery, coronary angioplasty, or stents compared to women without endometriosis, according to researchers.
Endometriosis is a chronic and estrogen-dependent gynecologic disorder that affects about 10 percent of women of reproductive age in the U.S. It is defined as the presence of endometrium-like tissue that thrives outside the uterus, primarily on the pelvic peritoneum and ovaries. Signs and symptoms include chronic pelvic pain, dysmenorrhea, dyspareunia, and reduced fertility. Endometriosis has been linked to heightened oxidative stress, systemic chronic inflammation, and an atherogenic lipid profile that may increase women’s risk for coronary heart disease (CHD).
“It is important for women with endometriosis — even young women — to adopt heart-healthy lifestyle habits, be screened by their doctors for heart disease, and be familiar with symptoms, because heart disease remains the primary cause of death in women,” Stacey A. Missmer, ScD, director of epidemiologic research in reproductive medicine at Boston’s Brigham and Women’s Hospital, said in a news release.
The team assessed the relationship between endometriosis and CHD in 116,430 women taking part in the Nurses’ Health Study II (1989 to 2009). The researchers excluded participants with a history of heart disease and stroke. In the 20 years of follow-up, there were 1,438 combined CHD events.
The results revealed that compared with women without endometriosis, women with endometriosis had a higher risk of myocardial infarction; angina; coronary artery bypass graft surgery/coronary angioplasty procedure/stent; or any of these CHD end points combined, regardless of the potential demographic, anthropometric, reproductive, family history, and lifestyle confounders.
Relative risk for the combined CHD end point was highest among women age 40 or younger and decreased as age increased.
According to the researchers, about 42 percent of the increased risk for CHD could be due to the surgical removal of the uterus or ovaries.
Among women with endometriosis, those who underwent a hysterectomy or oophorectomy had an increased risk for CHD compared with those who did not. Researchers also found that having surgically induced menopause at an early age seemed to be an important contributor.
“These data have implications for clinical management of endometriosis patients, suggesting that women with endometriosis may represent a high-risk group for CHD — particularly at a young age, indicating the need for risk awareness and subsequent screening for CHD and healthy lifestyle promotion among primary care and public health specialists,” the researchers wrote in their study.