Laparoscopically Confirmed Endometriosis and Risk of Incident Stroke: A Prospective Cohort Study
Open accessAbstract
Background: Prior research suggests that women with endometriosis are at greater risk of coronary heart disease. Therefore, our objective was to prospectively investigate the association between laparoscopically confirmed endometriosis and risk of incident stroke during 28 years of follow-up. Methods: Participants in the NHSII cohort study (Nurses’ Health Study II) were followed from 1989 when they were between the ages of 25 to 42 until 2017 for development of incident stroke (ischemic and hemorrhagic). Cox proportional hazard models were used to calculate hazard ratios and 95% CI, with adjustment for potential confounding variables (alcohol intake, body mass index at age 18, current body mass index, age at menarche, menstrual cycle pattern in adolescence, current menstrual cycle pattern, parity, oral contraceptive use history, smoking history, diet quality, physical activity, NSAID use, aspirin use, race/ethnicity, and income). We estimated the proportion of the total association mediated by history of hypertension, hypercholesterolemia, hysterectomy/oophorectomy, and hormone therapy. We also tested for effect modification by age (<50, ≥ 50 years), infertility history, body mass index (<25, ≥ 25 kg/m 2 ), and menopausal status. Results: We documented 893 incident cases of stroke during 2 770 152 person-years of follow-up. Women with laparoscopically confirmed endometriosis had a 34% greater risk of stroke in multivariable-adjusted models (hazard ratio, 1.34 [95% CI, 1.10–1.62]), compared to those without a history of endometriosis. Of the total association of endometriosis with risk of stroke, the largest proportion was attributed to hysterectomy/oophorectomy (39% mediated [95% CI, 14%–71%]) and hormone therapy (16% mediated [95% CI, 5%–40%]). We observed no differences in the relationship between endometriosis and stroke by age, infertility history, body mass index, or menopausal status. Conclusions: We observed that women with endometriosis were at elevated risk of stroke. Women and their health care providers should be aware of endometriosis history, maximize primary cardiovascular prevention, and discuss signs and symptoms of cardiovascular disease.
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References 46 · Cited by 67
Research works printed but not linked: 1
- [19]Pardanani S, Barbieri RL. The gold standard for the surgical diagnosis of endometriosis: Visual findings or biopsy results? J Gynecol Tech. 1998; 4: 121– 124
- Authors
- Farland, L. V., Degnan, W. J., Bell, M. L., Kasner, S. E., Liberman, A. L., Shah, D. K., Rexrode, K. M., & Missmer, S. A.
- Affiliations
- University of Arizona (US)
- University of Pennsylvania (US)
- Weill Cornell Medicine (US)
- Brigham and Women's Hospital (US)
- Harvard University (US)
- ORCID
- Venue
- Stroke
- Published
- 2022-10
- Volume
- 53
- Issue
- 10
- Pages
- 3116-3122
- ISSN
- 0039-2499 (ISSN-L)
- 1524-4628
- PMC
- PMC9529799
- OpenAlex
- W4286007703
- Cited by
- 67
- References
- 46
- Citations by year
- 2026: 13 · 2025: 24 · 2024: 16 · 2023: 11 · 2022: 3
- FWCI
- 11.38
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Stroke (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (U01HL145386, R01HL088521)
- National Cancer Institute (U01CA176726)
- National Institute of Neurological Disorders and Stroke (F32NS010764, U24NS107224)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD057210, R21HD099623, R01HD096033)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Epidemiology › Infective Endocarditis Diagnosis and Management
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ectopic Pregnancy Diagnosis and Management
- Keywords
- endometriosis, ischemic stroke, hemorrhagic stroke, hysterectomy, oophorectomy, hormone therapy, mediation analysis, cardiovascular risk, women's health, Nurses' Health Study II, primary prevention of cardiovascular disease, menopause, body mass index, infertility, oral contraceptive use, hypertension, hypercholesterolemia, age at menarche, parity
- MeSH terms
- Adolescent, Adult, Anti-Inflammatory Agents, Non-Steroidal, Aspirin, Contraceptives, Oral, Endometriosis, Female, Hormones, Humans, Infertility, Middle Aged, Pregnancy, Prospective Studies, Risk Factors, Cohort Studies, Stroke
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