Effects of medical and surgical treatment on the risk of major adverse cardiovascular and cerebrovascular events in Asian women with endometriosis

Abstract

Background: Endometriosis is linked to major adverse cardiovascular and cerebrovascular events (MACCE). However, whether this finding can be applied to the Asian population remained unanswered. Additionally, results are still inconsistent for the impact of endometriosis treatment on incidental MACCE. Thus, we intended to investigate the association between endometriosis and MACCE, and study the effect of endometriosis therapies on the risk of MACCE among Asian women. Methods: The Taiwan National Health Insurance Research Database was used for this retrospective population-based cohort study from 1997 to 2013. A total of 17 543 patients with endometriosis aged between 18 and 50 years were identified from a general population of 1 million after excluding diagnoses of major cardiovascular disease (CVD) and cerebrovascular accident (CVA) prior to endometriosis. The comparison group (n = 70 172) without endometriosis was selected by matching the study cohort with age, sex, and income and urbanization levels in a 4:1 ratio. Demographic data and the frequency of comorbidities between groups were compared using the independent t test and chi-square test. The incidence and risk of MACCE were analyzed using the log-rank test and a multivariate Cox proportional hazards model. Results: During a median follow-up period of 9.2 years, Asian women with endometriosis had a significantly higher frequency of comorbidities, medical and surgical treatment, and MACCE than did their non-endometriosis counterparts (2.76% vs 2.18%, P < .001). After adjustment for comorbidities, patients with endometriosis had an approximately 1.2-fold increased risk of MACCE (95% CI 1.05-1.29; P = .005) and a higher cumulative incidence of MACCE compared with the normal population. Among women with endometriosis, neither medical nor surgical treatment increased the risk of MACCE, including major CVD and CVA. Furthermore, medical treatment for endometriosis appeared to be protective against MACCE in the endometriosis females. Conclusion: Asian women with endometriosis not only had a higher frequency of comorbidities but also an increased risk of MACCE compared with the general population. In addition, the safety concern about medical or surgical treatment of endometriosis on the risk of MACCE was not evident in this study.