Endometriosis and cardiovascular disease

Abstract

Endometriosis is a chronic gynecological disease affecting one in ten reproductive-age women. It is defined as the presence of endometrium-like tissue outside the uterus. Beyond this placid anatomical definition, endometriosis is a complex, hormonal, inflammatory, and systemic condition that poses significant familial, psychological, and economic burden. The interaction between the cardiovascular system and endometriosis has become a field of interest as the underlying mutual mechanisms become better understood. On the basis of accumulating fundamental and clinical evidence, it is likely that there exists a close relationship between endometriosis and the cardiovascular system. Therefore, investigating the endometriosis– cardiovascular interaction is highly clinically significant. In this Review, we highlight our current understanding of the pathophysiology of endometriosis with systemic hormonal, proinflammatory, pro-angiogenic, immunologic, and genetic processes beyond the peritoneal microenvironment. Additionally, we provide current clinical evidence about how endometriosis interact with cardiovascular risk factors and cardiovascular disease. To date, only small associations between endometriosis and cardiovascular disease have been reported in observational studies, inherently limited by the potential influence of unmeasured confounding. Cardiovascular disease in women with endometriosis remains understudied, under-recognized and underdiagnosed. More detailed study of the cardiovascular-endometriosis interaction is needed to fully understand its clinical relevance, underlying pathophysiology, possible means of early diagnosis and prevention.

Screening and identification of key biomarkers associated with endometriosis using bioinformatics and next generation sequencing data analysis

“…The clinical incidence of endometriosis is high, and its main features include dysmenorrhea, dyspareunia, chronic pelvic pain, irregular uterine bleeding and infertility [3], which places a great burden on the economy of health and reduces quality of life in worldwide, 10% of women of reproductive age are diagnosed with endometriosis each year [4]. These patients have higher risks of gynecological cancer (ovarian, endometrial and cervical cancers) [5], polycystic ovary syndrome [6], cardiovascular diseases [7], obesity [8], gestational diabetes mellitus [9], diabetes mellitus [10] and hypertension [11]. Studies have revealed that the progression of endometriosis is related to genetic risk factors [12] as well as environmental factors [13].…”

Association of endometriosis with cardiovascular disease: Genetic aspects (Review)

“…Moreover, studies have reported a similar potential association between endometriosis and atherosclerotic CVD, underlying similar pathogenic mechanisms including coronary microvascular dysfunction, endothelial dysfunction and atherogenic lipid profile ( 18 , 19 ). There is an extended amount of literature focusing on the increased risk that women with endometriosis have for developing myocardial infarction, ischemic heart disease, hypertension, atherosclerosis requiring bypass and angioplasty or stenting procedures ( 16 , 20 - 24 ). However, CVD in women with endometriosis remains underdiagnosed and, therefore, detailed studies are required to fully understand the clinical relevance, as well as the underlying pathophysiological mechanisms of the interactions between these conditions.…”

Role of Renin-Angiotensin-Aldosterone System and Cortisol in Endometriosis: A Preliminary Report

“…Some patients experience debilitating endometriosis-associated pain that prevents them from usual activities. Chronic inflammation plays a central role in the pathogenesis of atherosclerosis, obesity, diabetes, and hypertension [3], which are often associated with endometriosis [4]. In particular, an increased risk of occurrence of hypertension, gestational hypertension and pre-eclampsia has been reported among women with endometriosis [3][4][5][6].…”

“…Chronic inflammation plays a central role in the pathogenesis of atherosclerosis, obesity, diabetes, and hypertension [3], which are often associated with endometriosis [4]. In particular, an increased risk of occurrence of hypertension, gestational hypertension and pre-eclampsia has been reported among women with endometriosis [3][4][5][6]. Several mechanisms, including pro-inflammatory, pro-angiogenic, and aberrant immune-endocrine function, involved in the pathobiology of endometriosis demonstrate compelling associations with cardiovascular disease development.…”