I Gs Winata, Immanuel Surya S, Leonardo Leonardo, Rinaldi Fransiskus X, Tandecxi Gabriel, Wijaya Richard
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Udayana, Denpasar, Indonesia.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Indonesia.
Narra J. 2025 Apr;5(1):e1935. doi: 10.52225/narra.v5i1.1935. Epub 2025 Feb 18.
Beyond gynecological issues, women with endometriosis have a significant risk of cardiac outcomes. Despite this evidence, the extent and mechanisms of the association remain unclear. The aim of this study was to evaluate the association between endometriosis and the incidence of cerebro-cardiovascular disorders. Using preferred reporting items for systematic review and meta-analyses (PRISMA) guidelines, seven databases were searched as of October 14, 2024, for observational studies assessing the association between endometriosis and cerebro-cardiovascular disorders. The main outcome was major adverse cardiovascular and cerebrovascular event (MACCE) while the secondary outcomes included all-cause mortality, cerebrovascular accident (CVA), ischemic heart disease (IHD), myocardial infarction (MI), arrhythmia, and heart failure (HF). Bias was assessed with the risk of bias in non-randomized studies of exposures (ROBINS-E) tool. Odds ratios with 95% confidence interval (CI) were calculated using random-effects meta- analysis. Evidence certainty was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Robustness was assessed via sensitivity analyses and trial sequential analysis (TSA). Out of 3,141 studies, nine cohort studies encompassing 1,670,589 women (follow-up 7-28 years) were included. Endometriosis was associated with 24% higher odds of MACCE incidence (95%CI: 1.18-1.31, moderate certainty). In addition, having endometriosis increased the odds of CVA by 49% (95%CI: 1.20-1.85, high certainty), IHD by 64% (95%CI: 1.31-2.05, low certainty), MI by 53% (95%CI: 1.18-1.98, high certainty), arrhythmias by 24% (95%CI: 1.12-1.37, high certainty), and HF by 13% (95%CI: 1.03-1.25, high certainty). Endometriosis did not significantly associate with all-cause mortality. Sensitivity analyses and TSA reinforced all of these findings. In conclusion, endometriosis was significantly associated with increased odds of cerebro-cardiovascular disorders. Future research should clarify the underlying mechanisms and develop targeted prevention strategies.
除了妇科问题外，患有子宫内膜异位症的女性有发生心脏相关后果的重大风险。尽管有这方面的证据，但这种关联的程度和机制仍不清楚。本研究的目的是评估子宫内膜异位症与心脑血管疾病发病率之间的关联。按照系统评价和荟萃分析的首选报告项目（PRISMA）指南，截至2024年10月14日，检索了七个数据库，以查找评估子宫内膜异位症与心脑血管疾病之间关联的观察性研究。主要结局是主要不良心脑血管事件（MACCE），次要结局包括全因死亡率、脑血管意外（CVA）、缺血性心脏病（IHD）、心肌梗死（MI）、心律失常和心力衰竭（HF）。使用暴露的非随机研究中的偏倚风险（ROBINS-E）工具评估偏倚。采用随机效应荟萃分析计算95%置信区间（CI）的比值比。使用推荐分级评估、制定和评价（GRADE）方法评估证据确定性。通过敏感性分析和试验序贯分析（TSA）评估稳健性。在3141项研究中，纳入了9项队列研究，涉及1670589名女性（随访7 - 28年）。子宫内膜异位症与MACCE发生率高24%相关（95%CI：1.18 - 1.31，中等确定性）。此外，患有子宫内膜异位症使CVA的发生率增加49%（95%CI：1.20 - 1.85，高确定性），IHD增加64%（95%CI：1.31 - 2.05，低确定性），MI增加53%（95%CI：1.18 - 1.98，高确定性），心律失常增加24%（95%CI：1.12 - 1.37，高确定性），HF增加13%（95%CI：1.03 - 1.25，高确定性）。子宫内膜异位症与全因死亡率无显著关联。敏感性分析和TSA强化了所有这些发现。总之，子宫内膜异位症与心脑血管疾病发生率增加显著相关。未来的研究应阐明潜在机制并制定有针对性的预防策略。
