Coexistence of endometriosis and cardiovascular diseases

There is a relationship between endometriosis and cardiovascular diseases depending on common underlying pathophysiologic mechanisms.

Key Points

Highlights:

• Etiopathogenetic mechanisms including systemic inflammation, pro-atherogenic lipid profile, enhanced oxidative stress, and endothelial dysfunction are responsible for the association between endometriosis and cardiovascular diseases.  

Importance:

• Women with endometriosis should be kept under control for the possibility of future cardiovascular diseases due to shared pathophysiologic mechanisms.

What’s done here?

• This review was conducted to assess the coexistence of endometriosis and cardiovascular diseases.
• Cardiovascular disease is the cause of 1 in 3 deaths in women each year while endometriosis is encountered with a prevalence of 10% in reproductive-aged women.
• Both endometriosis and cardiovascular diseases share common underlying pathophysiologic mechanisms.
• However, there is no robust dataset evaluating this relationship and the pathophysiology, pathogenesis, and prognosis of endometriosis in cardiovascular disease.

Key results:

• The literature presents insufficient clinical evidence about the coexistence of endometriosis and cardiovascular diseases.
• Despite this limitation, it has been shown that endometriosis patients are prone to develop atherosclerosis and cardiovascular diseases due to pro-inflammatory, pro-angiogenic, aberrant immune-endocrine environment, localized, and systemic inflammatory mechanisms of the disease.
• The main common underlying mechanisms of both diseases are chronic inflammation, enhanced oxidative stress, endothelial dysfunction, and cellular proliferation.
• Additionally, some genetic abnormalities such as variations at CDKN2BAS on chromosome 9p21 and locus 7q22 are found to be responsible for increased risk of cardiovascular diseases in endometriosis patients.
• Chronic hypertension, gestational hypertension, and preeclampsia are more frequently diagnosed in women with endometriosis since the inflammatory processes around endometriotic lesions and non-steroidal anti-inflammatory drug use for endometriosis-associated pelvic pain result in increased blood pressure.
• A strong association between endometriosis and altered lipid profile (higher levels of total cholesterol, LDL cholesterol, triglycerides, and HDL-cholesterol) has been shown due to dysregulated phospholipid and sphingolipid metabolisms.
• Regarding obesity, an important risk factor for cardiovascular diseases, there is an inverse relationship between body mass index and endometriosis.
• Cigarette use also has an inverse relationship with the presence of endometriosis while there are controversial data regarding the association between endometriosis and diabetes mellitus.
• Although the coexistence of endometriosis and coronary artery disease and stroke has been proposed based on limited data, endometriosis has no adverse effect on the hospital outcomes of these patients.
• Contrary to basic science, clinical data suggest that thromboembolic events are not increased in women with endometriosis.
• The relationship between endometriosis and arrhythmia and heart failure, which is claimed based on limited data, should be carefully investigated in further studies.
• Experimentally, it has been shown that medication used in cardiac diseases such as antiplatelet drugs and statin therapy decreases endometriotic lesions in size. 

Lay Summary

The most common presenting complaints are mainly pelvic pain and infertility, most of which relate to the menstrual period. Affected women demand therapy for these symptoms of endometriosis, notably pelvic pain. Several theories have been proposed to explain the development of endometriosis and abnormal angiogenesis, dysregulation of apoptotic mechanisms, oxidative stress, immune dysfunction, and stem cell theory are underlying pathophysiologic mechanisms. Because of underlying complex, hormonal, inflammatory, and systemic abnormalities, it has been recognized that cardiovascular diseases and endometriosis may coexist.

Marchandot et al., from France, published a review titled “Endometriosis and cardiovascular disease” in the "European Heart Journal Open". The authors investigated the relationship between endometriosis and cardiovascular diseases such as hypertension, obesity, hyperlipidemia, coronary artery disease, stroke, and heart failure.

It has been found to be an association between these diseases depending on scarce data in the literature. Obesity and cigarette use have only an inverse relationship with the presence of endometriosis. Additionally, the medication used for cardiac problems has an effect on reducing the size of endometriotic lesions.

“More detailed study of the cardiovascular-endometriosis interaction is needed to fully understand its clinical relevance, underlying pathophysiology, possible means of early diagnosis and prevention,” they added.

Research Source: https://pubmed.ncbi.nlm.nih.gov/35919664/