Department of Epidemiology and Biostatistics (L.V.F., W.J.D., M.L.B.), University of Arizona, Tucson.
Mel and Enid Zuckerman College of Public Health, and Department of Obstetrics and Gynecology, College of Medicine-Tucson (L.V.F.), University of Arizona, Tucson.
Stroke. 2022 Oct;53(10):3116-3122. doi: 10.1161/STROKEAHA.122.039250. Epub 2022 Jul 21.
Prior research suggests that women with endometriosis are at greater risk of coronary heart disease. Therefore, our objective was to prospectively investigate the association between laparoscopically confirmed endometriosis and risk of incident stroke during 28 years of follow-up.
Participants in the NHSII cohort study (Nurses' Health Study II) were followed from 1989 when they were between the ages of 25 to 42 until 2017 for development of incident stroke (ischemic and hemorrhagic). Cox proportional hazard models were used to calculate hazard ratios and 95% CI, with adjustment for potential confounding variables (alcohol intake, body mass index at age 18, current body mass index, age at menarche, menstrual cycle pattern in adolescence, current menstrual cycle pattern, parity, oral contraceptive use history, smoking history, diet quality, physical activity, NSAID use, aspirin use, race/ethnicity, and income). We estimated the proportion of the total association mediated by history of hypertension, hypercholesterolemia, hysterectomy/oophorectomy, and hormone therapy. We also tested for effect modification by age (<50, 50 years), infertility history, body mass index (<25, 25 kg/m), and menopausal status.
We documented 893 incident cases of stroke during 2 770 152 person-years of follow-up. Women with laparoscopically confirmed endometriosis had a 34% greater risk of stroke in multivariable-adjusted models (hazard ratio, 1.34 [95% CI, 1.10-1.62]), compared to those without a history of endometriosis. Of the total association of endometriosis with risk of stroke, the largest proportion was attributed to hysterectomy/oophorectomy (39% mediated [95% CI, 14%-71%]) and hormone therapy (16% mediated [95% CI, 5%-40%]). We observed no differences in the relationship between endometriosis and stroke by age, infertility history, body mass index, or menopausal status.
We observed that women with endometriosis were at elevated risk of stroke. Women and their health care providers should be aware of endometriosis history, maximize primary cardiovascular prevention, and discuss signs and symptoms of cardiovascular disease.
先前的研究表明，患有子宫内膜异位症的女性患冠心病的风险更高。因此，我们的目的是前瞻性地研究腹腔镜确诊的子宫内膜异位症与 28 年随访期间中风发病风险之间的关系。
NHSII 队列研究（护士健康研究 II）的参与者从 1989 年开始随访，当时他们的年龄在 25 至 42 岁之间，直至 2017 年发生中风（缺血性和出血性）。使用 Cox 比例风险模型计算风险比和 95%置信区间，并对潜在的混杂变量（饮酒量、18 岁时的体重指数、当前体重指数、初潮年龄、青春期的月经周期模式、当前的月经周期模式、产次、口服避孕药使用史、吸烟史、饮食质量、体育活动、非甾体抗炎药使用、阿司匹林使用、种族/民族和收入）进行调整。我们估计了由高血压、高胆固醇血症、子宫切除术/卵巢切除术和激素治疗史引起的总关联的比例。我们还通过年龄（<50 岁、50 岁）、不孕史、体重指数（<25、25kg/m）和绝经状态测试了效应修饰。
我们在 2770152 人年的随访中记录了 893 例中风事件。在多变量调整模型中，腹腔镜确诊的子宫内膜异位症女性中风风险增加 34%（风险比，1.34[95%CI，1.10-1.62]），与没有子宫内膜异位症病史的女性相比。子宫内膜异位症与中风风险之间的总关联中，最大的比例归因于子宫切除术/卵巢切除术（39%介导[95%CI，14%-71%]）和激素治疗（16%介导[95%CI，5%-40%]）。我们没有观察到子宫内膜异位症与中风之间的关系因年龄、不孕史、体重指数或绝经状态而存在差异。
我们观察到患有子宫内膜异位症的女性中风风险升高。女性及其医疗保健提供者应注意子宫内膜异位症病史，最大限度地进行心血管疾病的一级预防，并讨论心血管疾病的症状和体征。
