Increased risk of cardiovascular disease in women with endometriosis: a systematic review and meta-analysis

Abstract Background The association between endometriosis and cardiovascular disease remains poorly understood. Emerging evidence suggests a potential link between endometriosis and increased cardiovascular risk, necessitating a comprehensive evaluation. Purpose This study aimed to conduct a systematic review and meta-analysis to assess the risk of adverse cardiovascular outcomes in women with endometriosis compared to those without the condition. Methods A comprehensive search of online databases was performed up to November 2024 to identify studies comparing adverse cardiovascular outcomes in women with and without endometriosis. A random-effects model was employed for the meta-analysis to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Results The meta-analysis included seven studies encompassing a total of 1,407,875 participants. Women with endometriosis demonstrated a significantly increased risk of cerebrovascular disease (HR: 1.19, 95% CI: 1.13–1.24, p < 0.00001) and ischemic heart disease (HR: 1.35, 95% CI: 1.32–1.39, p < 0.00001). Additionally, the risk of major adverse cardiovascular events (HR: 1.15, 95% CI: 1.13–1.19, p < 0.00001) and arrhythmias (HR: 1.21, 95% CI: 1.17–1.25, p < 0.00001) was significantly elevated. However, no significant associations were observed for heart failure or all-cause mortality. Conclusion This meta-analysis indicates that women with endometriosis are at heightened risk for several cardiovascular conditions. These findings underscore the need for robust prospective studies to validate these associations and to explore underlying mechanisms.