The risk of stroke in women with a history of endometriosis
Reviewed by Nhi Le B.A. Posted on July 27th, 2022
The Nurse Health Study is a large longitudinal study funded by the National Institute of Health. This decades-long project has provided much insightful epidemiological knowledge about women’s health. Recently, the project was published in the American Heart Association journal reporting that women with a history of endometriosis have an elevated risk of stroke.
The prospective study followed 112,056 nurses for 28 years, and their endometriosis status was confirmed with laparoscopy. To enhance the internal validity of the data, confounding variables are adjusted for during analysis.
Those who have endometriosis experience hyperinflammation both at the local (in the peritoneal cavity) level and at the systemic level. This hyperinflammation is characterized by an elevated level of ICAM-1 (intra-cellular adhesion molecule 1), CRP (C-reactive protein), IL (interleukin)-1 and IL-6, TNF (tumor necrosis factor)-α, and VEGF (vascular endothelial growth factor). Most of these cytokines and chemokines have been reported to be associated with an elevated risk of cardiovascular disease.
Despite the large scale of the study, it has some limitations. One of which is that 93% of those included in the study are Caucasian, so their genetic background and risk profile might be more homogeneous, and the conclusion cannot be generalized to women of other races and ethnicities. However, other studies done in Asia had backed up the association between endometriosis and stroke. A retrospective cohort study in Taiwan found that women with endometriosis have a 20% higher risk of cerebrovascular events. Another cross-sectional study conducted in Japan concluded that those with endometriosis have double the risk of transient ischemic attack or cerebral infarction. Thus, it is important for physicians to monitor the cardiovascular health of their patients with a history of endometriosis and recommend appropriate prevention.
The prospective study followed 112,056 nurses for 28 years, and their endometriosis status was confirmed with laparoscopy. To enhance the internal validity of the data, confounding variables are adjusted for during analysis.
- These confounding variables are: alcohol intake, BMI at age 18, current BMI, age at menarche, menstrual cycle pattern in adolescence, current menstrual cycle pattern, parity, oral contraceptive use history, smoking history, diet quality, physical activity, NSAID use, aspirin use, and income.
Those who have endometriosis experience hyperinflammation both at the local (in the peritoneal cavity) level and at the systemic level. This hyperinflammation is characterized by an elevated level of ICAM-1 (intra-cellular adhesion molecule 1), CRP (C-reactive protein), IL (interleukin)-1 and IL-6, TNF (tumor necrosis factor)-α, and VEGF (vascular endothelial growth factor). Most of these cytokines and chemokines have been reported to be associated with an elevated risk of cardiovascular disease.
Despite the large scale of the study, it has some limitations. One of which is that 93% of those included in the study are Caucasian, so their genetic background and risk profile might be more homogeneous, and the conclusion cannot be generalized to women of other races and ethnicities. However, other studies done in Asia had backed up the association between endometriosis and stroke. A retrospective cohort study in Taiwan found that women with endometriosis have a 20% higher risk of cerebrovascular events. Another cross-sectional study conducted in Japan concluded that those with endometriosis have double the risk of transient ischemic attack or cerebral infarction. Thus, it is important for physicians to monitor the cardiovascular health of their patients with a history of endometriosis and recommend appropriate prevention.