Endometriosis leads to increased risk of heart attack and stroke in women

According to a study presented at the 2024 ESC Congress, women with endometriosis have a 20% higher risk of serious heart disease than women without endometriosis.

For decades, cardiovascular disease (CVD) was considered a male disease and risk factors were considered from a male perspective, for example, guidelines for CVD risk assessment included erectile dysfunction. Yet one in three women die from CVD and one in ten women suffers from endometriosis. Our results suggest that it may be time to routinely consider the risk of CVD in women with endometriosis.”

Dr. Eva Havers-Borgersen, lead author of the study, from Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark

The study used Danish nationwide registers of all women with a diagnosis of endometriosis between 1977 and 2021. They were matched at a ratio of 1:4 to women from the background population without endometriosis based on year of birth. The primary outcome was a composite of acute myocardial infarction and ischemic stroke. The secondary outcomes were the individual components of the primary outcome, as well as arrhythmias, heart failure, and mortality.

The analysis included 60,508 women with endometriosis and 242,032 matched controls (mean age 37.3 years) who were followed for a mean of 16 years and a maximum of 45 years.

Women with endometriosis had an approximately 20% increased risk for the combined endpoint of acute myocardial infarction and ischemic stroke compared to women 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 combined disease of acute myocardial infarction and ischemic stroke 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

When breaking down the individual components, women with endometriosis had an approximately 20% increased risk of ischemic stroke (adjusted HR 1.18; 95% CI 1.12-1.23) and an approximately 35% increased risk of acute myocardial infarction (adjusted HR 1.35; 95% CI 1.31-1.40) compared to women without endometriosis. In addition, women with endometriosis also had an 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 women without endometriosis.

Increasing evidence suggests that there is a close relationship between endometriosis and the cardiovascular system and that both may share common disease trajectories.3 Dr Havers-Borgersen concluded: “Although the absolute differences were small, the relative differences were 20%. Given the high prevalence of endometriosis, these results provide further evidence that female-specific risk factors and cardiovascular disease in women require more attention. We recommend that women with endometriosis undergo cardiovascular disease risk assessment. Now is the time to consider female-specific risk factors – such as endometriosis, but also gestational diabetes and preeclampsia – in cardiovascular risk prediction models. Further research is needed to confirm our findings and to incorporate these factors into effective risk prediction models.”