ArticleJournal of the American Heart Association2026
Association Between Endometriosis and Cardiovascular Disease: Insights From the UK Biobank.
Article in Journal of the American Heart Association, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundEndometriosis has been associated with a higher risk of cardiovascular disease (CVD), but the underlying mechanisms remain incompletely understood.
methodsUsing UK Biobank data, we assessed the relationship between endometriosis and CVD (defined as a composite of fatal and non-fatal coronary heart disease, peripheral artery disease, and stroke), cardiovascular mortality, and all-cause mortality, applying Cox regression analysis while adjusting for conventional and emerging, lifestyle and demographic, and female-specific CVD risk factors. Furthermore, we performed subgroup analysis across age and female-specific factors, and mediation analysis to study the role of hysterectomy and oophorectomy.
resultsWe included 264 740 women without CVD at baseline (median age 57 [25th-75th percentile 50-63] years; 8194 with endometriosis) from the UK Biobank. During 3 484 788 person-years of follow-up, 22 283 women developed CVD. Endometriosis was associated with an 18% higher risk of CVD (hazard ratio 1.18 [95% CI 1.10-1.28]), mainly driven by coronary heart disease (1.24 [1.12-1.37]). Conversely, endometriosis was related to a 12% lower risk of all-cause mortality (0.88 [0.80-0.98]). The association with cardiovascular mortality was not significant (0.85 [0.63-1.13]). Mediation analysis suggested that hysterectomy may partially mediate the association between endometriosis and CVD. Subgroup analyses did not yield significant differences.
conclusionsEndometriosis is associated with a higher risk of CVD, especially coronary heart disease. Mediation analysis suggests that hysterectomy partly explains this association. Whether hysterectomy may proxy endometriosis severity instead of being a true mediator remains to be elucidated. These findings highlight the need for studies that unravel the causal mechanisms linking endometriosis, its treatments, and cardiovascular outcomes.
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