Wei Chun-Hui, Chang Renin, Wan Yu Hsun, Hung Yao-Min, Wei James Cheng-Chung
Department of Obstetrics and Gynecology, Liouying Chi Mei Medical Center, Tainan, Taiwan.
Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Front Med (Lausanne). 2021 Jun 25;8:619664. doi: 10.3389/fmed.2021.619664. eCollection 2021.
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, < 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, = 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.
伴有慢性炎症的子宫内膜异位症（EM）可能会加速动脉粥样硬化的进展。目前，尚无大型或随机临床研究评估亚洲子宫内膜异位症患者心血管事件的发生率，以调查新发EM是否与新发冠状动脉疾病（CAD）的较高风险相关。在这项针对台湾全国队列的研究中，我们确定了从2000年1月1日至2012年12月31日新诊断为EM的13988例患者。EM组和非EM组按倾向评分以1:1的比例进行匹配。在总共27976名参与者中，有358人患CAD。随访期间，EM组的发病率高于非EM组（每1000人年1.8例 vs. 每1000人年1.3例）。在调整了人口统计学特征、合并症、手术程序、门诊就诊频率和药物治疗后，EM组CAD的调整后风险比（aHR）为1.52，95%置信区间为（1.23 - 1.87，<0.001）。分层分析显示，在四个年龄组（20 - 39岁、40 - 49岁、50 - 54岁和55岁以上）中，20 - 39岁亚组患CAD的风险较高（aHR，1.73；95%CI，1.16 - 2.59，=0.008）。进行了多项敏感性分析以进行交叉验证，结果显示一致的阳性结果。总之，这项队列研究表明，台湾有症状EM患者比无EM病历的患者后续患CAD的风险增加。需要进一步的前瞻性研究来证实这种因果关系。
