A concerning link between endometriosis and cardiovascular disease.

Adequate evidence on this link will be especially important for young female patients with endometriosis.

Key Points

Importance:

• Recent advances in cardiovascular diseases point to sex-specific factors such as polycystic ovary syndrome, hypertensive disorders of pregnancy, and primary ovarian insufficiency.

Highlights:

• Emerging research indicates that endometriosis may also contribute to adverse cardiovascular outcomes.

What's done here:

• A multinational author team penned this letter to highlight the importance of recognizing cardio-endometriosis as a new and developing research area.
• They discussed whether the available research warrants routine arteriosclerotic cardiovascular disease (ASCVD) risk evaluation in women with endometriosis.

Basic Outlines:

• Recent studies between endometriosis and adverse cardiovascular outcomes show a particular increasing risk of atherosclerosis and ASCVD.
• The mechanism of this association is still under investigation, while oxidative stress, chronic inflammation, hormonal imbalances, and vascular dysfunction are of interest.
• Research in this field comprises population cohort studies with self-completed questionnaires or electronic health records and Nurse's Health Studies.
• Hormonal status, either due to oophorectomy after the surgery or medical treatments, may worsen lipid and cardiovascular risk profiles, acting as a significant cofounder.
• Despite all this, preventive measures must be taken to protect patients from the possible association between endometriosis and ASCVD.

Lay Summary

Endometriosis is a disease characterized by endometrial-like tissues outside the uterus, which causes inflammation, scarring, and adhesion formation. The pathologic process of forming those adhesions releases proinflammatory molecules, cytokines, and growth factors that may have systemic effects. Recent research, for example, mentioned an increased risk of atherosclerotic diseases in women with endometriosis. Unfortunately, early diagnosis and effective treatment of endometriosis remain limited in current practice.

Under the leadership of Dr. Olivier Morel from the Division of Cardiovascular Medicine, Strasbourg University Hospital, Strasbourg, France, the research team analyzed five cohort studies regarding adverse cardiovascular outcomes, including women with endometriosis, some laparoscopically confirmed. In those dedicated studies, endometriosis has been associated with an increased risk of atherosclerotic cardiovascular disease (ASVCD) and increased morbidity. However, the determination of whether endometriosis by itself drives ASCVD is still unproven.

Endometriosis is known as a chronic disease with severe periodic pain, infertility, pelvic pain, and depression. Along with these symptoms, clinical findings such as hypertension, dyslipidemia, inflammation, genetic susceptibility, angiogenesis, and psychological disorders can lead to ASVCD. Surgically induced menopause also increases the risk of adverse cardiovascular changes. Another piece of evidence that highlights the increased risk of ASCVD in women with endometriosis is the adverse pregnancy outcomes and preeclampsia that result from experiencing heart attacks and strokes within seven years after delivery. Future population-based studies should contain cardiovascular imaging, some biomarkers such as troponins and NT-proBNP, and the impact of Lp-A levels in endometriosis to verify all these findings significantly.

With increased awareness of the interaction between ASVCD and endometriosis, the role of gynecologists in addressing cardiovascular health in young patients becomes important. This will also facilitate early diagnosis and appropriate management. 

In their recent article published in the European Journal of Preventive Cardiology, the authors concluded: "Further research should focus on epidemiologic cohorts and data, aiming for a definitive causality between endometriosis and ASVCD."

Research Source: https://pubmed.ncbi.nlm.nih.gov/38421615/