Risk of cardiovascular disease and mortality among women with endometriosis: A systematic review and meta-analysis

Abstract

Introduction: Endometriosis is a chronic and estrogen-dependent disorder that affects about 10% of women of reproductive age worldwide. Endometriosis has been associated with chronic inflammation and an atherogenic lipid profile, two conditions that increase the risk of atherothrombotic cardiovascular diseases. Material and Methods: A literature search for relevant studies published from the earliest record to 31 March 2025 was conducted in MEDLINE and EMBASE databases. The following MESH terms were searched: “stroke,” “cerebrovascular disease,” “cardiovascular disease,” “coronary heart disease,” “ischemic heart disease,” “mortality,” and “endometriosis.” The results of each study were pooled, and an overall estimate of relative risk was obtained with a random-effect model. Homogeneity between studies was analyzed using I2 statistics. This review was not registered. Results: Ten studies were eligible for inclusion in this meta-analysis. Five studies reported an increased risk of stroke with endometriosis, with a pooled risk of 1.18 (95% confidence intervals [95% CI] [1.13–1.22]). Four studies reported an increased risk of coronary heart disease with endometriosis, with a pooled risk of 1.36 (95% CI [1.32–1.40]). Four studies reported an increased risk of composite cardiovascular disease with endometriosis, with a pooled risk of 1.16 (95% CI [1.12–1.20]). Although the homogeneity is high in results, the confounding factors considered in the different studies vary. Thus, these results must be interpreted with caution. Conclusions: Endometriosis is associated with an increased risk of cardiovascular disease. Further research is required to confirm these findings. However, these results highlight the importance of considering primary cardiovascular prevention strategies for women with endometriosis.