Females with endometriosis had a higher incidence of hospitalization for cardiovascular disease compared to females without endometriosis, according to a study using ICES data.
Endometriosis is a common condition and affects approximately 10% of the female population. Limited data suggest that endometriosis could be a cardiovascular disease (CVD) risk factor, but there are few population-based studies that include females of different socioeconomic backgrounds.
“Cardiovascular disease is the leading cause of death for women globally,” says lead author Jessica Blom, a fourth-year resident with the department of obstetrics and gynaecology at Queen’s University. “If we want to reduce the incidence of heart disease, it’s important to explore the risk factors that are unique to younger females.”
The study, published in CMAJ Open, used administrative health data from Ontario residents from 1993 to 2015. 166,835 females with endometriosis were included and matched to 333,706 females without endometriosis. The primary outcome was hospitalization due to CVD, which included heart attack, stroke, heart failure, and several other types of heart disease.
The data showed that:
- Compared to females without endometriosis, those with endometriosis had an increased risk of hospitalization for a major CVD event, even after adjusting for demographic variables like age, immigration status, and pre-existing health conditions.
- Females with endometriosis also had an increased risk of hospitalization for secondary CVD events, such as minor stroke, angina, and irregular heart rhythm.
- Risk for these events was not different between those diagnosed medically (when physicians rely on a patient’s symptoms and/or pelvic exam) versus individuals with a confirmed diagnosis during surgery.
Notably, the risk of CVD appears to be associated with the timing of endometriosis diagnosis, with a higher risk for females who are diagnosed at a younger age.
“Unfortunately, there are still significant delays in the diagnosis of endometriosis, which could mean younger women are exposed to untreated inflammation for a number of years,” says senior author Olga Bougie, gynecologic surgeon and assistant professor in the department of obstetrics and gynaecology at Queen’s University. “While we are still exploring the mechanism of how endometriosis increases heart disease risk, our findings suggest that timely diagnosis and treatment should be a consideration for policy-makers and healthcare providers.”
One limitation of the study is that there lacked information about lifestyle factors that could modify CVD risk, such as exercise, smoking, and diet. The study also did not have information on the stage of endometriosis or treatments (including drugs such as NSAIDs and opioids), which could affect the risk of CVD.
This is the largest population-based study to date that explores the association between endometriosis and CVD, and the first to include a diverse population of females. Findings suggest that this common disease could be a risk factor for earlier onset of heart disease and should be investigated as part of CVD screening in women.
The study, “Endometriosis as a risk factor for premature cardiovascular disease: a population-based cohort study” was published in CMAJ Open.
Author block: Blom J, Velez M, McClintock C, Shellenberger J, Pudwell J, Brogly SB, Bougie O.
ICES is an independent, non-profit research institute that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. In October 2018, the institute formerly known as the Institute for Clinical Evaluative Sciences formally adopted the initialism ICES as its official name. For the latest ICES news, follow us on Twitter: @ICESOntario
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