Risk of cardiovascular outcomes among women with endometriosis in the United Kingdom: a retrospective matched cohort study

BJOG. 2021 Sep;128(10):1598-1609. doi: 10.1111/1471-0528.16692. Epub 2021 Apr 6.


Objective: To describe the prevalence and incidence of endometriosis and to estimate the risk of cardiovascular outcomes in women with endometriosis.

Design: Population-based cohort study using The Health Improvement Network database.

Setting: UK primary care.

Population: Women aged 16-50 years were followed from 1995 to 2018.

Methods: Adjusted hazard ratios (aHR) for cardiovascular outcomes comparing women with endometriosis with those without endometriosis were estimated using multivariable Cox regression models. Prevalence and incidence of endometriosis were estimated using annual (1998-2017) sequential cross-sectional and cohort studies, respectively.

Main outcome measure: The primary outcome was composite cardiovascular disease (CVD) including, ischaemic heart disease (IHD), heart failure (HF) and cerebrovascular disease. Secondary outcomes were arrhythmia, hypertension and all-cause mortality.

Results: In all, 56 090 women with endometriosis and 223 669 matched controls without endometriosis were included in the analysis of cardiovascular risk. Compared with women without endometriosis, the aHR for cardiovascular outcomes among women with endometriosis were: composite CVD 1.24 (95% CI 1.13-1.37); IHD 1.40 (95% CI 1.22-1.61); cerebrovascular disease 1.19 (95% CI 1.04-1.36); HF 0.76 (95% CI 0.54-1.07); arrhythmia 1.26 (95% CI 1.11-1.43); hypertension 1.12 (95% CI 1.07-1.17) and all-cause mortality 0.66 (95% CI 0.59-0.74). The incidence of endometriosis was 12.3 per 10 000 person-years in 1998 and 11.5 per 10 000 person-years in 2017. The prevalence of endometriosis increased from 119.7 per 10 000 population in 1998 to 201.3 per 10 000 population in 2017.

Conclusion: Endometriosis is associated with an increased risk of cardiovascular outcomes. Young women with endometriosis are a potential target for CVD risk assessment and prevention.

Tweetable abstract: Endometriosis is associated with increased risk of cardiovascular outcomes: a UK retrospective matched cohort study.

Keywords: Arrhythmia; cardiovascular disease; endometriosis; hypertension; stroke.

MeSH terms

  • Adolescent
  • Adult
  • Cardiovascular Diseases / epidemiology*
  • Cardiovascular Diseases / etiology
  • Cohort Studies
  • Databases, Factual
  • Endometriosis / complications*
  • Female
  • Humans
  • Middle Aged
  • Retrospective Studies
  • Risk Factors
  • United Kingdom / epidemiology
  • Young Adult