Atherosclerotic cardiovascular disease in women with endometriosis: A critical review of risk factors and prospects for early surveillance

ABSTRACT Endometriosis and atherosclerotic cardiovascular disease (ASCVD) share similar pathogenic mechanisms. Hence, this systematic review evaluates the association between endometriosis and lifetime ASCVD risk including co-prevalence with dyslipidemia, atherosclerosis, and non-invasive markers of endothelial dysfunction. Among 12 studies (401 patients with surgically proven endometriosis and 557 controls), two prospective-cohort studies demonstrated an increased lifetime ASCVD risk after controlling for demographic and lifestyle confounders in women with endometriosis, as measured by higher incidence of myocardial infarction, angiography-confirmed angina, or requiring coronary artery bypass graft surgery (RR1.35-1.62). Relative risks of developing hypercholesterolemia and hypertension were 1.25 and 1.14, respectively, which are supported by other studies that demonstrate higher serum Lp(a) and lower PON-1 levels in women with endometriosis that was negatively correlated with stage of disease (r=−0.74, P