Endometriosis is associated with a 1.22 increased risk of all-cause cardiovascular diseaseEndometriosis linked to higher risk of cardiovascular disease

This meta-analysis investigated the relationship between endometriosis (EM) and cardiovascular disease (CVD) risk. The study analyzed data from cohort studies involving a large population of 3,100,610 participants who were either diagnosed with or did not have endometriosis. The primary objective was to determine if the presence of EM is associated with an increased risk of all-cause CVD.

The analysis focused on several specific cardiovascular outcomes, including myocardial infarction, coronary artery disease, cerebrovascular events, and heart failure. The study also performed subgroup analyses based on geographic regions, specifically looking at Asian, North American, and European cohorts to identify potential regional variations in the association between EM and cardiovascular risk.

The primary outcome of all-cause CVD showed a significant increased risk associated with EM, with an effect size of 1.22 (95% CI: 1.08-1.38; I = 94.6%). Specific secondary outcomes also demonstrated significant associations: myocardial infarction showed an increased risk with an effect size of 1.29 (95% CI: 1.10-1.50), and coronary artery disease showed a higher increase with an effect size of 1.47 (95% CI: 1.29-1.67). Additionally, cerebrovascular events were associated with an increased risk in patients with EM, showing an effect size of 1.18 (95% CI: 1.12-1.25).

In contrast, the analysis found no significant association between endometriosis and heart failure. Regional analyses provided further nuance to the data; both Asian cohorts (effect size 1.36; 95% CI: 1.25-1.48) and North American cohorts (effect size 1.37; 95% CI: 1.16-1.61) showed an increased risk of CVD associated with EM. However, the European cohort did not show a significant association with EM, reporting an effect size of 0.93 (95% CI: 0.64-1.34).

Safety and tolerability data were not reported in this meta-analysis as it evaluated an existing condition rather than a pharmacological intervention. Methodological limitations were not specifically detailed, but the study notes that because these findings are derived from cohort studies, a direct causal link between endometriosis and cardiovascular disease has not been established.

These results suggest that patients with endometriosis may be at a higher risk for specific types of cardiovascular events, particularly myocardial infarction and coronary risks. This highlights a potential need for targeted cardiovascular monitoring in clinical practice for patients with EM, especially those identified in high-risk populations such as the Asian or North American cohorts. However, clinicians should note that the risk for heart failure was not significantly associated with EM.

Several questions remain regarding the underlying mechanisms driving these associations and why the association was not significant in European cohorts. Further research is needed to determine if specific biomarkers can identify which patients with endometriosis are at the highest risk for cardiovascular complications. Clinical decisions should be made with the understanding that while a statistical association exists, the causality of CVD by endometriosis is not established.