Watch out for CVD in patients with these non-malignant conditions, researchers say.
Non-cancerous gynaecological diseases increase the risk of cardiovascular and cerebrovascular disease, according to Australian and international researchers.
In their meta-analysis including more than 3.2 million people, the researchers found that participants with non-malignant gynaecological disease (NMGD) had a 28% higher relative risk of composite cardiovascular and cerebrovascular disease (C/CVD).
Participants with gynaecological disease had 41% higher risk of ischaemic heart disease and a 33% higher risk of cerebrovascular disease, according to the international study involving researchers from the University of Sydney, Western Sydney University and Nepean Hospital.
PCOS was associated with a 42% higher risk of ischaemic heart disease and a 47% higher risk of cerebrovascular disease, while endometriosis was associated with 36% and 24% higher risks respectively, the researchers wrote in Heart.
The findings suggested that patients with gynaecological disease should be monitored.
“Awareness of this association would allow healthcare professionals to advise patients regarding risk-reducing behavioural changes and interventions, to potentially prevent or delay the onset of or reduce the severity of C/CVD.
“Furthermore, healthcare professionals would be aware to monitor their patients with NMGD for early signs and symptoms of C/CVD, and potentially diagnose atypical presentations of C/CVD with the knowledge of the underlying risk for this group of patients.
“Management strategies for C/CVD in this patient group could be tailored to the hypothesised underlying mechanisms that connect these conditions: systemic inflammation and female steroid hormones.”
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Inflammation and oxidative stress were key triggers for cardiovascular and cerebrovascular disease, they said.
“When considering endometriosis specifically, the mechanism believed to link this condition to increased cardiovascular risk is systemic inflammation.
“Similarly, in PCOS, a cross-sectional analysis found a significant association between low-grade inflammation and sympathetic dysfunction and hyperandrogenism.
“As such, inflammation may be an underlying mechanism for an association between NMGD and C/CVD.”
The researchers said it was possible that gynaecological risk factors and cardiovascular risk factors overlap, potentially acting as confounders.
“For instance, features of metabolic syndrome, a complex interaction of visceral obesity, dyslipidaemia, hyperglycaemia and hypertension has been consistently shown to be present in individuals with PCOS. Metabolic syndrome is associated with an increased risk of C/CVD events and mortality.”
The researchers said a 2019 Western Sydney University showed that almost three in four assigned females at birth reported dysmenorrhea, one in nine were diagnosed with endometriosis by age 44, and around one in five had PCOS.
Therefore, “any association with C/CVD is likely to affect millions of people assigned female at birth worldwide”, they said.
