Abstract
Endometriosis (EM) with chronic inflammation may accelerate the progression of atherosclerosis. Currently, no large or randomized clinical studies have assessed the incidence of cardiovascular events in patients with endometriosis in Asia to investigate whether incident EM is associated with a higher risk of new-onset coronary artery disease (CAD). In this study of a nationwide cohort in Taiwan, we identified 13,988 patients with newly diagnosed EM from 1 January, 2000, through 31 December, 2012. EM and non-EM groups were matched by propensity score at a ratio of 1:1. Of a total 27,976 participants, 358 developed CAD. The incidence rate in the EM group was higher than that in the non-EM group (1.8 per 1,000 person-years vs. 1.3 per 1,000 person-years) during the follow-up period. The adjusted hazard ratio (aHR) of CAD for the EM group was 1.52 with a 95% confidence interval (1.23–1.87, p < 0.001) after adjusting for demographic characteristics, comorbidities, surgical procedures, frequency of outpatient visits, and medications. Stratified analysis revealed that, among four age groups (20–39, 40–49, 50–54, and above 55 years), the 20–39 years sub-group was associated with a higher risk of CAD (aHR, 1.73; 95% CI, 1.16–2.59, p = 0.008). Several sensitivity analyses were conducted for cross-validation, and it showed consistent positive findings. In conclusion, this cohort study revealed that patients with symptomatic EM in Taiwan were associated with increased risk of subsequent CAD than patients without medical records of EM. Further prospective studies are needed to confirm this causal relationship.
Highlights
Endometriosis (EM) is a common estrogen-dependent gynecologic disorder that is prevalent in reproductive-aged women [1–3], and EM is defined as extrauterine endometrial glands and stromal growth primarily on ovaries and the pelvic peritoneum [2, 3]
Compared to the non-EM group, the crude hazard ratios (HRs) for coronary artery disease (CAD) for the EM group was 1.46
The adjusted HR for CAD for the EM group was 1.52 in comparison with the non-EM group after adjusting for confounding factors
Summary
Endometriosis (EM) is a common estrogen-dependent gynecologic disorder that is prevalent in reproductive-aged women [1–3], and EM is defined as extrauterine endometrial glands and stromal growth primarily on ovaries and the pelvic peritoneum [2, 3]. It occurs in about 8.9% of the general population in Taiwan [4]. Higher serum levels of low-density lipoprotein and lower high-density lipoprotein have been found in women with EM [14–16] These are all risk factors that may accelerate the progression of atherosclerosis and contribute to the incidence of coronary artery disease (CAD), which can be fatal in advanced countries, including Taiwan. Mortality rates decreased by as much as 50% in the 1990s and 2000s, over four million people have died annually from CAD in over 49 countries in Europe and North Asia [17]
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