Women with endometriosis may be at higher risk of coronary heart disease

Women with endometriosis – especially those 40 or younger – may have a higher risk of heart disease, according to new research published in Circulation: Cardiovascular Quality and Outcomes [1]. Surgically induced menopause may contribute to this risk.

This study is the first prospective investigation to examine the link between coronary heart disease and endometriosis.

Researchers reviewed the records of 116,430 women enrolled in the Nurses’ Health Study II. Endometriosis was surgically diagnosed in 11,903 women by end of follow-up.

During 20 years of follow-up, researchers found that compared to women without endometriosis, women with the condition were:

1.35 times more likely to need surgery or stenting to open blocked arteries;
1.52 times more likely to have a heart attack; and
1.91 times more likely to develop angina (chest pain).

Moreover, women with endometriosis aged 40 or younger were three times as likely to develop heart attack, chest pain, or need treatment for blocked arteries, compared to women without endometriosis in the same age group.

Fan Mu ScD
Brigham and Women’s Hospital and Harvard Medical School, USA

Women with endometriosis should be aware that they may be at higher risk for heart disease compared to women without endometriosis, and this increased risk may be highest when they are young

said Fan Mu ScD, the study’s lead author, who was a research assistant at Brigham and Women’s Hospital and Harvard Medical School in Boston, USA, when the study was conducted. She presented preliminary results of this data at the 2012 annual meeting of the American Society for Reproductive Medicine.

Do treatments for endometriosis contribute to this risk?

Researchers noted that hysterectomy for endometriosis may partly account for the increased risk of heart disease. It is known that surgically-induced menopause prior to natural menopause may increase risk of heart disease, and this elevated risk may be more evident at younger ages [2-5].

Professor Stacey Missmer
Brigham and Women’s Hospital and Harvard Medical School

We observed that about 40% of the risk of heart disease among women with endometriosis could be attributed to surgical menopause. That means that there are other important factors related to endometriosis that are conferring risk. However, we cannot ignore that surgical menopause may be impacting the risk of heart disease in women with endometriosis. This is particularly critical to consider given that many women who undergo a hysterectomy to relieve their endometriosis-associated pain are dismayed to find that it is often not a cure.

Furthermore, 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.

said senior study author Stacey A Missmer ScD,

Director of Epidemiologic Research in Reproductive Medicine at Brigham and Women’s Hospital and Scientific Director of the Boston Center for Endometriosis.

Study limitations

The study accounted for oral contraceptive and hormone replacement therapy exposure but could not evaluate details of other hormonal treatments for endometriosis; inclusion of women with endometriosis suspected by clinicians but not confirmed by surgery did not change the results.

Despite these limitations, the large number of women enrolled, length of follow up, and ability to account for many risk factors for heart disease strengthen these findings.

References

Mu F, et al. Endometriosis and risk of coronary heart disease. Circ Cardiovasc Qual Outcomes 2016 Epub.
Rivera CM, et al. Increased cardiovascular mortality after early bilateral oophorectomy. Menopause 2009;16:15-23.
Parker WH, et al. Long-term mortality associated with oophorectomy compared with ovarian conservation in the nurses’ health study. Obstet Gynecol 2013;121:709-16.
Ingelsson E, et al. Hysterectomy and risk of cardiovascular disease: a population-based cohort study. Eur Heart J 2011;32:745-50.
Howard BV, et al. Risk of cardiovascular disease by hysterectomy status, with and without oophorectomy: the Women’s Health Initiative Observational Study. Circulation 2005;111:1462-70.

Acknowledgment

This study was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The Nurses’ Health Study II is supported by the Public Health Service grants from the National Cancer Institute, NIH, US Department of Health and Human Services.