Endometriosis Linked to Elevated Risk of Heart Attack, Stroke in Women

Eva Havers-Borgersen, MD

Credit: ResearchGate

Women with endometriosis have an approximately 20% greater risk of significant cardiac outcomes, including acute myocardial infarction and ischemic stroke, compared with women without endometriosis, according to new data presented at the European Society of Cardiology (ESC) Congress 2024.¹

The study utilized nationwide registries in Denmark to identify all women with a diagnosis of endometriosis between 1977 and 2021, ultimately including 60,508 women with endometriosis and 242,032 matched controls.

“For decades, cardiovascular disease (CVD) has been thought of as a man’s disease and risk factors have been considered from the male perspective, for example, including erectile dysfunction in guidelines on CVD risk assessment,” said Eva Havers-Borgersen, MD, Rigshospitalet Copenhagen University Hospital.² “Yet, 1 in 3 women die from CVD and 1 in 10 women suffer from endometriosis.”

Approximately 10% of reproductive-aged women are affected by endometriosis. Using the Danish nationwide registries, investigators matched women with endometriosis to women without the condition in a 1:4 ratio based on birth year.

For this analysis, the primary outcome was the composite of acute myocardial infarction and ischemic stroke.¹ The secondary outcome comprised the individual components of the primary outcome, and arrhythmia, heart failure, and mortality.

Among the study population, the median age was 37.3 years. These women were followed for a median of 16 years and a maximum of 45 years.

Upon analysis, women with endometriosis experienced an approximately 20% increased risk of the composite endpoint of acute myocardial infarction and ischemic stroke, compared with those without endometriosis (unadjusted hazard ratio [HR], 1.18; 95% CI, 1.14–1.23; adjusted HR, 1.15; 95% CI, 1.11–1.20).

Moreover, the 40-year cumulative incidence of the composite primary outcome was 17.5% (95% CI, 16.6–18.2) and 15.3% (95% CI, 15.0–15.7) in women with and without endometriosis, respectively.

After breaking it down into individual components, Havers-Borgersen found women with endometriosis had around a 20% increased risk of ischemic stroke (adjusted HR, 1.18; 95% CI, 1.12–1.23) and around 35% increased risk of acute myocardial infarction (adjusted HR, 1.35; 95% CI, 1.31–1.40), compared with women without endometriosis.

An increased risk of arrhythmia (adjusted HR, 1.21; 95% CI, 1.17–1.25) and heart failure (adjusted HR, 1.11; 95% CI, 1.05–1.18) was identified in women with endometriosis, compared with those without the condition.

“Our results suggest that it may be time to routinely consider the risk of CVD in women with endometriosis,” Havers-Borgersen added.²

An increasing amount of evidence has pointed to a close relationship between endometriosis and the cardiovascular system, including a potential common disease pathway.³ Noting a small absolute difference, but a relative difference of 20%, Havers-Borgersen indicated these results showed that female-specific risk factors for CVD in women require further attention.²

“We suggest that women with endometriosis undergo CVD risk assessment, and it is now time for female-specific risk factors – such as endometriosis, but also gestational diabetes and preeclampsia – to be considered in cardiovascular risk prediction models,” Havers-Borgersen added.² “Further research is needed to confirm our findings and integrate these factors into effective risk prediction models.”

References

1. _{Havers-Borgersen E, Hartwell D, Ekelund C, Butt JH, et al. Endometriosis – a prevalent disease – is associated with significant cardiovascular disease. Presented at the European Society of Cardiology (ESC) Congress 2024. London England. 30 August – 2 September, 2024.}
2. _{European Society of Cardiology (ESC). Women with endometriosis at greater associated risk of heart attack stroke. Published 29 August 2024. Accessed 30 August 2024.}
3. _{Marchandot B, Curtiaud A, Matsushita K, et al. Endometriosis and cardiovascular disease [published correction appears in Eur Heart J Open. 2024 Jan 16;4(1):oead137. doi: 10.1093/ehjopen/oead137]. Eur Heart J Open. 2022;2(1):oeac001. Published 2022 Feb 2. doi:10.1093/ehjopen/oeac001}