3. Cardiovascular Risk in Females with Endometriosis

Abstract

Background

Individuals with endometriosis are at higher risk of cardiovascular (CV) disease, hypertension, high cholesterol, and atherosclerosis. While CV disease is rare in young people, surrogate markers such as the pulse wave velocity (PWV), a measure of arterial stiffness, can predict future CV dysfunction. We sought to determine if females with endometriosis had elevated PWV values, and thus increased CV risk, compared with healthy control subjects. We also investigated whether additional predictors of future CV risk correlated with PWV measurements.

Methods

At the baseline visit of a multi-site, randomized clinical trial, n=70 females with laparoscopically-confirmed endometriosis and persistent pelvic pain provided health history and anthropometric measures. Blood samples were obtained for measurement of inflammatory markers (hs-CRP, ESR), lipid profiles (HDL, LDL), and hormonal concentrations (estradiol). PWV was collected by using two pressure probes placed at the carotid artery and femoral artery. The time it takes the pressure wave to go from the upstream probe to the downstream probe provides the Pulse Transit Time. PWV is calculated by dividing the distance traveled by the transit time. Previously obtained normative data from n=1455 from healthy controls were used as reference. Generalized linear regression models with adjustments for age, endometriosis stage and BMI were developed to test the associations of interest. We had local IRB approval.

Results

Of the n=70 participants, n=63 (median (interquartile (IQR)) age 25.3 (13.2) y, range 16.1–39.2y)) had PWV scans adequate for analysis. All were using hormonal therapy: 10 (15.9%) combined-hormonal contraception, 27 (42.9%) oral progestin, 31(49.2%) LNG IUD, and 11 (17.5%) other. Participants were excluded for other CV disease risk (n=2 high cholesterol, n=1 hypertension). Demographic and clinical characteristics are summarized in Table 1. About 30% of participants had stage I endometriosis. Median (IQR) PWV was 5.1 (1.2) m/s, lower than normative values for this age range (median=6.1-6.4 m/s for ages < 30 – 39). Respective associations between PWV and hs-CRP, ESR, HDL, and estradiol were nonsignificant (p> 0.15). LDL was positively associated with PWV (regression coefficient (β)=0.02, 95% CI=[0.01, 0.03], p< 0.01).

Conclusions

Females with endometriosis had lower PWV measurements compared to age-matched control subjects. LDL was positively associated with PWV; other CV risk markers were not. In this sample, young females with endometriosis did not demonstrate early signs of increased CV risk as measured by PWV. Future studies should investigate the impact of duration of disease and use of hormonal treatment on these findings.