Endometriosis and atherosclerotic cardiovascular disease

Early diagnosis and treatment of endometriosis could help to reduce the incidence of atherosclerotic cardiovascular disease if this relationship is certain.

Key Points

Importance:

• Chronic inflammation, oxidative stress, and endothelial dysfunction are the common pathogenetic reasons for both endometriosis and atherosclerosis.

Highlights:

• Current evidence shows that women with endometriosis are at higher lifetime risk of developing atherosclerotic cardiovascular disease than those without endometriosis.

What's done here:

• All electronic databases systematically searched up to May 2018 to determine the potential association between endometriosis and atherosclerotic cardiovascular diseases.

Key Results:

• Only 12 studies are found eligible among all reviewed literature and included in the qualitative analysis. 
• The association between surgically confirmed endometriotic patients and subsequent atherosclerotic cardiovascular disease demonstrated an increased risk when compared to women without endometriosis. Moreover, this association was higher among younger patients and those who underwent a hysterectomy and/or oophorectomy.
• The relative risk of developing hypercholesterolemia and hypertension was statistically high.
• in some studies, flow-mediated dilatation was significantly low and there was no linear association between flow-mediated dilatation and severity of endometriosis.
• A case-control study showed higher values of endothelial dysfunction among endometriotic patients.
• Most of the studies found no significant difference in serum markers of inflammation between women with or without endometriosis. 

Lay Summary

Endometriosis and atherosclerotic cardiovascular disease show the same pathologic mechanism in terms of endothelial dysfunction.

Tan et al. from the Department of Obstetrics and Gynecology, the University of British Columbia, Vancouver, Canada reviewed the literature aiming to determine whether women with endometriosis are candidates of the high-risk population for lifelong atherosclerotic cardiovascular diseases. Their paper is recently published in the journal named "Reproductive Biomed Online".

The diagnosis of endometriosis in women is made in their premenopausal years that makes the pelvic pain and infertility the primary point of interest, while atherosclerosis typically manifests later in life. For this reason, clear identification of a link between endometriosis and atherosclerotic cardiovascular disease would allow preventing women with endometriosis from the life-threating disease.  

The systemic review of electronic databases including biomarkers of atherogenic dyslipidemia, endothelial dysfunction, and subclinical atherosclerosis considers the evidence for associations between endometriosis and atherosclerotic cardiovascular disease. 

The most valuable research would be a large population-based, prospective study, and/or should include measurements of subclinical disease markers among women with laparoscopically identified endometriosis.

Endothelial dysfunction is the first step in the atherosclerotic process and precedes vascular structural alteration. The markers of endothelial function measured systematically or in the peritoneal cavity in these selected publications showed variable results.

In conclusion, robust evidence of atherosclerotic cardiovascular disease and endometriosis is still lacking and future studies are necessary to evaluate the relationship between those two clinical situations.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/31735549