Endometriosis and long-term cardiovascular risk: a nationwide Danish study

Author:

Havers-Borgersen Eva1ORCID,Hartwell Dorthe2,Ekelund Charlotte23,Butt Jawad H14ORCID,Østergaard Lauge1ORCID,Holgersson Christine1,Schou Morten35ORCID,Køber Lars13,Fosbøl Emil L13

Affiliation:

1. Department of Cardiology, Rigshospitalet, Copenhagen University Hospital , Blegdamsvej 9, 2100 Copenhagen , Denmark

2. Department of Gynecology and Obstetrics, Rigshospitalet, Copenhagen University Hospital , Copenhagen , Denmark

3. Department of Clinical Medicine, University of Copenhagen , Copenhagen , Denmark

4. Department of Cardiology, Zealand University Hospital , Roskilde , Denmark

5. Department of Cardiology, Gentofte Hospital , Hellerup , Denmark

Abstract

Abstract Background and Aims Endometriosis, a systemic gynaecological disease affecting 10% of women in reproductive age, shares pathophysiological characteristics with cardiovascular disease. However, data on the relationship between endometriosis and cardiovascular outcomes are scarce, prompting this study to address the knowledge gap. Methods Using Danish nationwide registries, women diagnosed with endometriosis (1977–2021) were identified and matched with controls in a 1:4 ratio based on year of birth. The primary outcome was a composite of acute myocardial infarction and ischaemic stroke. The secondary outcomes were arrhythmias, heart failure, and mortality. Results In total, 60 508 women with endometriosis and 242 032 matched controls were included (median age 37.3 years). Women with endometriosis were more comorbid and used more medications than controls. The incidence rates of the composite outcomes were 3.2 [95% confidence interval (CI) 3.2–3.3] and 2.7 (95% CI 2.7–2.8) per 1000 person-years among women with and without endometriosis, respectively. Women with endometriosis had a significantly higher associated rate of the composite outcome compared with controls [unadjusted hazard ratio (HR) 1.18 (95% CI 1.14–1.23), adjusted HR 1.15 (95% CI 1.11–1.20)]. Likewise, women with endometriosis were also at significantly increased associated risk of arrhythmias [unadjusted HR 1.24 (95% CI 1.20–1.28) and adjusted HR 1.21 (95% CI 1.17–1.25)] and heart failure [unadjusted HR 1.16 (95% CI 1.09–1.22) and adjusted HR 1.11 (95% CI 1.05–1.18)] but at decreased risk of mortality [unadjusted HR 0.95 (95% CI 0.92–0.97) and adjusted HR 0.93 (95% CI 0.91–0.96)]. Conclusions Women with endometriosis have a higher associated long-term risk of cardiovascular outcomes compared with controls. Despite subtle absolute risk differences, the high prevalence of endometriosis underscores the importance of these findings.

Publisher

Oxford University Press (OUP)

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