Mu Fan, Rich-Edwards Janet, Rimm Eric B, Spiegelman Donna, Forman John P, Missmer Stacey A
From the Department of Epidemiology (F.M., J.R.-E., E.B.R., D.S., S.A.M.), Department of Nutrition (E.B.R., D.S.), and Department of Biostatistics (D.S.), Harvard T.H. Chan School of Public Health, Boston, MA; Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, MA (J.R.-E.); and Channing Division of Network Medicine, Department of Medicine (E.B.R., J.P.F., S.A.M.), Renal Division, Department of Medicine (J.P.F.), and Department of Obstetrics, Gynecology, and Reproductive Biology (S.A.M.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
Hypertension. 2017 Jul;70(1):59-65. doi: 10.1161/HYPERTENSIONAHA.117.09056. Epub 2017 May 30.
An altered hormonal or chronic systemic inflammatory milieu characterizing endometriosis may result in a higher risk of hypercholesterolemia and hypertension. Conversely, elevated low-density lipoprotein in hypercholesterolemia and chronic systemic inflammation resulting from hypertension may increase the risk of endometriosis. We assessed the association of laparoscopically confirmed endometriosis with hypercholesterolemia and hypertension in a large prospective cohort study. In 1989, 116 430 registered female nurses aged 25 to 42 completed the baseline questionnaire and were followed for 20 years. Multivariable Cox proportional hazards models were applied. In 1989, there were 4244 women with laparoscopically confirmed endometriosis and 91 554 women without. After adjusting for demographic, anthropometric, family history, reproductive, dietary, and lifestyle risk factors prospectively, comparing women with laparoscopically confirmed endometriosis to women without, the relative risks were 1.25 (95% confidence interval, 1.21-1.30) for development of hypercholesterolemia and 1.14 (95% confidence interval, 1.09-1.18) for hypertension. Conversely, the relative risks of developing laparoscopically confirmed endometriosis were 1.22 (95% confidence interval, 1.15-1.31) comparing women with hypercholesterolemia to women without and 1.29 (95% confidence interval, 1.18-1.41) comparing women with hypertension to women without. The strength of associations of laparoscopically confirmed endometriosis with hypercholesterolemia or hypertension was strongest among women aged ≤40 and weakened as age increased ( values for interaction <0.001). We observed that ≈45% of the associations between endometriosis and hypercholesterolemia and hypertension could be accounted for by treatment factors after endometriosis diagnosis, including greater frequency of hysterectomy/oophorectomy and earlier age for this surgery. In this large cohort study, laparoscopically confirmed endometriosis was prospectively associated with increased risk of hypercholesterolemia and hypertension. Conversely, hypercholesterolemia and hypertension were prospectively associated with higher risk of laparoscopically confirmed endometriosis.
子宫内膜异位症所具有的激素改变或慢性全身性炎症环境，可能会导致高胆固醇血症和高血压风险升高。反之，高胆固醇血症中低密度脂蛋白升高以及高血压导致的慢性全身性炎症，可能会增加子宫内膜异位症的风险。在一项大型前瞻性队列研究中，我们评估了经腹腔镜确诊的子宫内膜异位症与高胆固醇血症和高血压之间的关联。1989年，116430名年龄在25至42岁之间的注册女护士完成了基线调查问卷，并接受了20年的随访。应用多变量Cox比例风险模型。1989年，有4244名经腹腔镜确诊为子宫内膜异位症的女性和91554名未患该病的女性。在对人口统计学、人体测量学、家族史、生殖、饮食和生活方式等危险因素进行前瞻性调整后，将经腹腔镜确诊为子宫内膜异位症的女性与未患该病的女性进行比较，高胆固醇血症发生的相对风险为1.25（95%置信区间为1.21 - 1.30），高血压发生的相对风险为1.14（95%置信区间为1.09 - 1.18）。反之，将高胆固醇血症女性与未患该病的女性进行比较，经腹腔镜确诊为子宫内膜异位症的相对风险为1.22（95%置信区间为1.15 - 1.31）；将高血压女性与未患该病的女性进行比较，经腹腔镜确诊为子宫内膜异位症的相对风险为1.29（95%置信区间为1.18 - 1.41）。经腹腔镜确诊的子宫内膜异位症与高胆固醇血症或高血压之间的关联强度在年龄≤40岁的女性中最强，并随着年龄增长而减弱（交互作用值<0.001）。我们观察到，子宫内膜异位症与高胆固醇血症和高血压之间约45%的关联可由子宫内膜异位症诊断后的治疗因素解释，包括子宫切除术/卵巢切除术的频率更高以及该手术的年龄更早。在这项大型队列研究中，经腹腔镜确诊的子宫内膜异位症前瞻性地与高胆固醇血症和高血压风险增加相关。反之，高胆固醇血症和高血压前瞻性地与经腹腔镜确诊的子宫内膜异位症风险升高相关。
