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Study links endometriosis to higher risk of coronary heart disease

Women with endometriosis may have higher risk of heart attack, angina, or having bypass surgery or angioplasty, new research indicates. These risks were more pronounced in women under age 40.

Endometriosis is a gynecologic condition in which tissue that resembles endometrium (the lining of the uterus) grows outside the uterus. According to background information provided in the study, it affects approximately 10 per cent of women. Common symptoms include painful periods, pelvic pain and reduced fertility.

Using data from the long-term Nurses’ Health Study, researchers at Harvard T.H. Chan School of Public Health and Brigham and Women’s Hospital in Boston, Massachusetts compared incidence of coronary heart disease among women with endometriosis and the rest of the study group. The study included 20 years’ of data (1989-2009) on 116,430 nurses who participated in the study, 11,903 of whom had been diagnosed with endometriosis.  

The researchers found that women with endometriosis had 62 per cent increased risk of coronary heart disease compared to the rest of the study group. This included a 52 per cent increased risk of heart attack and 35 per cent increased risk of having a coronary artery bypass graft or an angioplasty, as well as almost double the risk of angina (91 per cent increased risk) compared to women without endometriosis.

The study also showed significant differences in these risks by age group. Women ages 40 and under with endometriosis had the highest relative risk: triple the risk of coronary heart disease compared to women without endometriosis. The relative risk decreased with age, shrinking to a 65 per cent increased risk for women in their 40s, and a 44 per cent increased risk for women ages 51 to 55. After age 55, risk of coronary heart disease was not significantly different between women with endometriosis and the rest of the study group.

Treatment options for endometriosis include hysterectomy and oophorectomy (surgical removal of the ovaries), so these surgeries were more common among women with endometriosis in the study. Since these procedures can increase heart disease risks in women who have them at a younger age, the study authors looked at how these treatments might influence their findings. They found that 42 per cent of the relationship between endometriosis and coronary heart disease was due to the higher rate of hysterectomy and oophorectomy in the endometriosis group. They estimated that about 50 per cent of the relationship cannot be explained by these or other treatments.

The study authors note that endometriosis has already been linked to chronic inflammation, increased oxidative stress and a blood lipid profile associated with atherosclerosis. These factors are also linked to coronary heart disease, and may contribute to the link between endometriosis and coronary heart disease.

The researchers also note that these results should be taken into consideration when weighing the risks and benefits of treating endometriosis with hysterectomy and oophorectomy.

The study was led by Fan Mu, ScD, and was published in the AHA journal Circulation: Cardiovascular Quality and Outcomes on March 29, 2016.   

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  • A publication of:
  • Women's College Hospital