Women with endometriosis are at higher risk of significant cardiac outcomes compared to women without the condition, according to a new study presented at the European Society of Cardiology (ESC) Congress 2024 in London.
The researchers highlighted the need to start routinely considering the risk of cardiovascular disease (CVD) in women with endometriosis after results showed these women have around a 20% greater risk of acute myocardial infarction or ischaemic stroke compared to women without endometriosis.
Using Danish nationwide registries of all women with a diagnosis of endometriosis between 1977 and 2021 (n=60,508), the researchers matched the cohort with women from the background population without endometriosis (n=242,032) in a 1:4 ratio based on year of birth. They were followed for a median of 16 years and a maximum of 45 years.
The primary outcome was a composite of acute myocardial infarction and ischaemic stroke, while the secondary outcomes included the individual components of the primary outcome, as well as arrhythmias, heart failure and mortality.
Women with endometriosis had around a 20% increased risk of the composite endpoint of acute myocardial infarction and ischaemic stroke compared with those without endometriosis (unadjusted hazard ratio [HR] 1.18; 95% confidence interval [CI] 1.14−1.23; adjusted HR 1.15; 95% CI 1.11−1.20).
The 40-year cumulative incidence of the primary outcome was 17.5% (95% CI 16.6−18.2%) and 15.3% (95% CI 15.0−15.7%) in women with and without endometriosis, respectively (p<0.0001).
When it came to the secondary endpoints, women with endometriosis had around a 20% increased risk of ischaemic stroke (adjusted HR 1.18; 95% CI 1.12−1.23) and around 35% increased risk of acute myocardial infarction (adjusted HR 1.35; 95% CI 1.31−1.40) compared to those without endometriosis.
Women with endometriosis also had increased risk of arrhythmias (adjusted HR 1.21; 95% CI 1.17−1.25) and heart failure (adjusted HR 1.11; 95% CI 1.05−1.18) compared to those without the condition.
Commenting on the results, lead study author Dr Eva Havers-Borgersen, a medical doctor and PhD fellow in cardiology at Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark, said: ‘Although the absolute differences were small, the relative differences were 20%, and with the high prevalence of endometriosis, these results provide more evidence that female-specific risk factors and CVD in women need greater attention.’
The researchers have called for women with endometriosis to undergo CVD risk assessment, with Dr Havers-Borgersen adding, ‘it is now time for female-specific risk factors – such as endometriosis, but also gestational diabetes and pre-eclampsia – to be considered in cardiovascular risk prediction models’.
They also highlight the need for further research to confirm their findings and support the integration of these factors into effective risk prediction models, as well as increasing awareness to ensure that risk factors and symptoms of CVD in women are recognised and reported.
The abstract ‘Endometriosis, a prevalent disease, is associated with significant cardiac disease‘ was presented at ESC Congress 2024 during the Cardiovascular disease in women (5) session on 2 September at 9am BST.
