Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark.
Department of Gynecology and Obstetrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Eur Heart J. 2024 Nov 21;45(44):4734-4743. doi: 10.1093/eurheartj/ehae563.
Endometriosis, a systemic gynaecological disease affecting 10% of women in reproductive age, shares pathophysiological characteristics with cardiovascular disease. However, data on the relationship between endometriosis and cardiovascular outcomes are scarce, prompting this study to address the knowledge gap.
Using Danish nationwide registries, women diagnosed with endometriosis (1977-2021) were identified and matched with controls in a 1:4 ratio based on year of birth. The primary outcome was a composite of acute myocardial infarction and ischaemic stroke. The secondary outcomes were arrhythmias, heart failure, and mortality.
In total, 60 508 women with endometriosis and 242 032 matched controls were included (median age 37.3 years). Women with endometriosis were more comorbid and used more medications than controls. The incidence rates of the composite outcomes were 3.2 [95% confidence interval (CI) 3.2-3.3] and 2.7 (95% CI 2.7-2.8) per 1000 person-years among women with and without endometriosis, respectively. Women with endometriosis had a significantly higher associated rate of the composite outcome compared with controls [unadjusted hazard ratio (HR) 1.18 (95% CI 1.14-1.23), adjusted HR 1.15 (95% CI 1.11-1.20)]. Likewise, women with endometriosis were also at significantly increased associated risk of arrhythmias [unadjusted HR 1.24 (95% CI 1.20-1.28) and adjusted HR 1.21 (95% CI 1.17-1.25)] and heart failure [unadjusted HR 1.16 (95% CI 1.09-1.22) and adjusted HR 1.11 (95% CI 1.05-1.18)] but at decreased risk of mortality [unadjusted HR 0.95 (95% CI 0.92-0.97) and adjusted HR 0.93 (95% CI 0.91-0.96)].
Women with endometriosis have a higher associated long-term risk of cardiovascular outcomes compared with controls. Despite subtle absolute risk differences, the high prevalence of endometriosis underscores the importance of these findings.
子宫内膜异位症是一种影响 10%生育年龄女性的全身性妇科疾病，其病理生理学特征与心血管疾病相似。然而，关于子宫内膜异位症与心血管结局之间关系的数据很少，这促使本研究来填补这一知识空白。
利用丹麦全国性登记处，于 1977 年至 2021 年期间诊断为子宫内膜异位症的女性患者（n=60508）与年龄匹配的 4 倍对照组女性（n=242032）进行 1:4 匹配。主要结局为急性心肌梗死和缺血性卒中的复合结局。次要结局为心律失常、心力衰竭和死亡率。
共纳入 60508 例子宫内膜异位症女性和 242032 例匹配对照组女性（中位年龄 37.3 岁）。与对照组相比，子宫内膜异位症患者合并症更多，用药更多。子宫内膜异位症组和对照组复合结局的发生率分别为 3.2 [95%置信区间（CI）3.2-3.3]和 2.7 [95%CI 2.7-2.8]每 1000 人年。与对照组相比，子宫内膜异位症患者发生复合结局的风险显著更高[未调整的风险比（HR）1.18（95%CI 1.14-1.23），调整后的 HR 1.15（95%CI 1.11-1.20）]。同样，子宫内膜异位症患者发生心律失常[未调整 HR 1.24（95%CI 1.20-1.28）和调整 HR 1.21（95%CI 1.17-1.25）]和心力衰竭[未调整 HR 1.16（95%CI 1.09-1.22）和调整 HR 1.11（95%CI 1.05-1.18）]的风险也显著增加，但死亡风险降低[未调整 HR 0.95（95%CI 0.92-0.97）和调整 HR 0.93（95%CI 0.91-0.96）]。
与对照组相比，患有子宫内膜异位症的女性发生心血管结局的长期风险更高。尽管绝对风险差异较小，但子宫内膜异位症的高患病率突出了这些发现的重要性。
