Women with endometriosis at greater risk for stroke

Women with endometriosis were at greater risk for stroke even after accounting for known risk factors, according to a study presented at the ASRM Scientific Congress & Expo.

“Cardiovascular disease presents differently between women and men, and we know that women have a higher incidence of first CVD event as stroke,” Leslie V. Farland, ScD, MSc, assistant professor in the department of epidemiology and biostatistics at the University of Arizona’s Mel and Enid Zuckerman College of Public Health, said during the presentation.

“Prior research has also suggested that certain reproduction conditions such as parity, irregular menstrual cycles, miscarriage and adverse pregnancy outcomes are associated with CVD risk,” Farland continued.

According to previous studies, the researchers noted, women with endometriosis are at greater risk for CVD later in life. Endometriosis and stroke may have similar underlying pathophysiologic mechanisms as well, they added.

The researchers examined data from the Nurses’ Health Study II, which followed 116,429 nurses aged 25 to 42 years from 1989 until 2017 for development of incident stroke.

The study addressed confounding variables including alcohol intake, BMI, parity, oral contraceptive use history, smoking history, diet quality, physical activity, race and income.

Also, the researchers estimated the proportion of the total effect mediated by factors potentially on the causal pathway between endometriosis and stroke including history of hypertension, hypercholesterolemia, diabetes, gestational diabetes, hysterectomy and oophorectomy, as well as hormonal therapy.

The cohort included 893 incident cases of stroke. Women who had endometriosis confirmed by laparoscopy had a 36% greater risk for stroke in multivariable models adjusted for potential confounding factors (RR = 1.36; 95% CI, 1.12-1.66).

“During our mediation analysis, we tried to quantify the proportion of the total effect of endometriosis on stroke that could be attributed to potential mediators,” Farland said.

Hormone therapy accounted for 15.5% of the association between endometriosis and incident stroke risk (95% CI, 5.1%-39.9%). Hysterectomy and oophorectomy accounted for 38.9% of that association (95% CI, 14.6%-70.9%). There were no differences in the relationship between endometriosis and stroke based on age, infertility history, BMI or menopausal status.

“We see that women with endometriosis had a greater risk of incident of stroke than women without endometriosis, and that was true both in our age-adjusted model as well as in our multivariable adjusted model adjusting for those potential confounding factors,” Farland said.

There were no changes in results during the sensitivity analyzes, nor was there any effect modification, the researchers said.

“Women and their healthcare providers should be aware of their gynecologic history when counseling patients and discuss risk factors, signs and symptoms for cardiovascular disease,” Farland said.