Atherosclerotic cardiovascular disease and endometriosis

Current scientific clues point to pathogenetic similarities between endometriosis and atherosclerotic cardiovascular disease

Key Points

Highlights:

• Scientific evidence suggests that young women with endometriosis and possibly older women with a history of endometriosis may have a higher risk of atherosclerotic cardiovascular disease, particularly if early menopause is induced.
• There are important common pathogenetic features between endometriosis and ASCVD necessitating further collaborative multidisciplinary research.

Background:

• Atherosclerotic cardiovascular disease is the leading cause of death in women, with an incidence rising sharply after menopause.
• Young female patients with endometriosis may have a higher lifetime risk of developing cardiovascular disease which may be unrecognized owing to the young age of women.
• Understanding the mechanisms linking endometriosis with ASCVD would guide the implementation of new therapies to mitigate the increased cardiovascular disease burden. 

Key points:

• Mechanisms proposed to explain the possible relationship between endometriosis and ASCVD include the followings:
  • Common pathogenesis of chronic inflammation in both;
  • Genetic similarities;
  • MicroRNA dysfunction;
  • Association between endometriosis and early menopause, a well-established risk for developing ASCVD. 

Conclusion: 

• Physicians primarily focus on traditional risk factors when evaluating an individual female patient’s risk of developing ASCVD, a history of endometriosis could be included as a possible risk factor.
• In order to assess the risks of ASCVD both at diagnosis of endometriosis and during follow-up future research is warranted.
• A multidisciplinary approach is in need to improve the lifetime health of patients with endometriosis in regard to ASCVD.

Lay Summary

Dr. Omur Taskin and associates from British Columbia, Canada, have recently published a review regarding the potential link between atherosclerotic cardiovascular disease (ASCVD) and endometriosis in The Journal of Minimally Invasive Gynecology.

Atherosclerotic cardiovascular disease is the leading cause of death in women, with an incidence rising sharply after menopause There are many clinical clues suggesting young women with endometriosis and possibly older women with a history of endometriosis have a higher risk of atherosclerotic cardiovascular disease, particularly with induced early menopause.

Two recent large-scale studies showed a higher risk of myocardial infarction, angiographically confirmed angina, coronary artery bypass graft surgery, coronary angioplasty procedure or stenting, or a combination of these, in female patients with laparoscopically confirmed endometriosis.

Pathogenetic pathways to explain the possible relationship between endometriosis and ASCVD include a common chronic inflammatory status, genetic similarities, microRNA dysfunction and an association between endometriosis and early menopause, which is a well-established risk for developing and atherosclerotic cardiovascular disease. 

Physicians primarily focus on traditional risk factors when evaluating an individual female patient’s risk of developing atherosclerotic cardiovascular disease, hence the presence of a history of endometriosis should be included as a possible risk factor.

Understanding the mechanisms linking endometriosis with atherosclerotic cardiovascular disease may introduce new therapies to mitigate the increased cardiovascular disease burden.

It is clear that future research is warranted in this regard implementing a multidisciplinary approach.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/?term=31028947