medwireNews: Women with gynecologic disorders may be at increased risk for cardiovascular or cerebrovascular disease (C/CVD) compared with women without gynecologic disorders, suggests a systematic review and meta-analysis published in Heart.
Women with at least one nonmalignant gynecologic disease (NMGD), including endometriosis, polycystic ovary syndrome (PCOS), dysmenorrhea, or irregular menstrual cycles, had a significant 28% greater risk for developing a composite C/CVD outcome, comprising ischemic heart disease, cerebrovascular disease, heart failure, and peripheral vascular disease, than women without NMGD.
In their systematic review and meta-analysis of 28 studies involving a total of 3,271,242 individuals, investigators Giorgia Elisabeth Colombo (Ospedale Regionale di Lugano, Switzerland) and colleagues “found an overall association between NMGD and C/CVD across all studies.”
For individual C/CVD outcomes, women with an NMGD had a significant 41% higher risk for ischemic heart disease and a significant 33% higher risk for cerebrovascular disease, compared with those without an NMGD.
And further analysis of individual NMGDs suggested “the risk of C/CVD and its components was greater among those with a history of endometriosis or [PCOS],” say the investigators, with the risk increased a significant 30% and 28%, respectively.
Colombo et al caution, however, that they observed a high level of heterogeneity between the reviewed studies and identified a serious or critical risk for bias in more than half, mainly driven by a lack of control for potential confounders. Additionally, no studies examining associations between atrial fibrillation and NMGD were eligible for the review, preventing its inclusion in the composite C/CVD outcome.
Nevertheless, the investigators say that “[p]hysicians should be aware of the potential association between NMGD and C/CVD and use this to inform clinical practice in order to mitigate the risk of C/CVD.”
They add that “[m]anagement 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.”
Among the 3,271,242 individuals assessed, 992,475 had endometriosis, PCOS, dysmenorrhea, or irregular menstrual cycles, and 2,278,767 did not have an NMGD. The study settings included the UK, USA, Northern Europe, Canada, Australia, Taiwan, China, and South Korea.
When considering only the small number of studies that accounted for whether C/CVD occurred after or before NMGD, the researchers said their analyses “showed no significant difference in effect estimates.”
As temporality is important for causal inference, they conclude that the association between C/CVD and NMGD “requires further exploration with high-quality longitudinal studies adjusted for confounders to establish temporal relationships and causality.”
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