Endometriosis is a chronic and estrogen-dependent gynecologic disorder that affects 10% of women of reproductive age. It is defined as the presence of Endometriosis like tissue thriving outside the uterus, primarily on the pelvic peritoneum and ovaries (Missmer et.al, 2016). The signs and symptoms include chronic pelvic pain, dysmenorrhea, dyspareunia, and reduced fertility. The researchers in their study on Endometriosis and Risk of Coronary Heart Disease published in the March edition of Circulation: Cardiovascular Quality and Outcomes, shows that endometriosis is linked to systemic chronic inflammation, heightened oxidative stress, and an atherogenic lipid profile.
The study looked at more than 116,000 women enrolled in the Nurses’ Health Study II, the researchers found nearly 12,000 women who received a diagnosis of endometriosis during the 20-year follow-up, which ended in 2009. Various inflammatory factors, markers of oxidative stress and serum levels of low-density lipoprotein have been shown to increase but a decrease of antioxidants and high-density lipoprotein in the peritoneal fluid and peripheral blood among women with endometriosis. Inflammation, oxidative stress, and an atherogenic lipid profile play key roles in the pathogenesis of coronary heart disease (CHD). Chronic systemic inflammation contributes to vascular insult and atheromatous plaque progression. Elevated concentration of low-density lipoprotein enhances its retention under the arterial wall, retention and oxidation of low-density lipoprotein are fundamental events in atherogenesis. In contrast, high-density lipoprotein is antiatherogenic, removing cholesterol from cells in the arterial wall. Therefore, the presence of endometriosis may promote coronary artery atherosclerosis formation and progression, increasing the risk of CHD.
When compared with women without endometriosis, laparoscopically confirmed endometriosis was associated with a significantly increased risk of myocardial infarction, angiographically confirmed angina, and coronary artery bypass graft surgery/angioplasty/stent. Hysterectomy/oophorectomy was associated with a higher risk of CHD and explained a portion of the association between endometriosis and CHD. Apart from these biological mechanisms, it is possible that the crude association between endometriosis and CHD can be explained by CHD risk factors that predate and cause endometriosis (eg, diet). The study confirms that endometriosis was associated with higher risk of CHD. The association was stronger among young women. Hysterectomy/ oophorectomy were associated with higher risk of CHD and could explain a portion of the association between endometriosis and CHD. These suggests that women with endometriosis may represent a high-risk group for CHD—particularly at a young age, indicating the need for risk awareness and subsequent screening for CHD and healthy lifestyle promotion among women of reproductive age.
Missmer SA, Hankinson SE, Spiegelman D, Barbieri RL, Marshall LM, Hunter DJ. Incidence of laparoscopically confirmed endometriosis by demographic, anthropometric, and lifestyle factors. Am J Epidemiol. 2004;160:784–796. doi: 10.1093/aje/kwh275
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