Uterine fibroids linked to elevated heart disease risk: Study

Long-term heart disease risk in women diagnosed with uterine fibroids was more than 80% higher than in women without fibroids, according to new independent research published today in the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association.

Fibroids are predominately benign growths that develop from the muscle tissue of the uterus. The U.S. Office of Women’s Health notes that as many as 20%-and possibly up to 80%-of women will develop fibroids by the time they reach age 50.

“Nearly 26 million pre-menopausal women in the U.S. are impacted by uterine fibroids and many do not experience any symptoms. Yet despite the high prevalence, fibroids are understudied and poorly understood,” said study author Julia D. DiTosto, M.S., a Ph.D. Candidate in Epidemiology at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. “Some studies have shown that fibroids and cardiovascular disease share biological pathways, including the growth of smooth muscle cells, the excessive buildup of fibrous connective tissue, calcification and inflammatory responses.”

DiTosto noted that those findings have been hindered by limitations including small study sample sizes that lacked diversity and insufficient study design.

“We set out to address these critical gaps using a large, diverse dataset with extended follow-up,” she said. “Our findings suggest that fibroids may serve as an important marker for identifying women at elevated cardiovascular risk, with sustained increased risk persisting up to 10 years after diagnosis.”

Researchers looked at a U.S. database of health information from 2000 to 2022. They studied more than 450,000 females (average age 41 years) with fibroids compared to nearly 2,251,000 females who had not been diagnosed with the fibroids. Over the next decade, researchers monitored for incidences of coronary artery disease (including heart attack), cerebrovascular disease (stroke and related conditions) and peripheral artery disease.

They found:

• After 10-years of follow-up, women with fibroids were at higher risk for all three major conditions (coronary artery, cerebrovascular and peripheral artery diseases).
• The risk of developing cardiovascular disease was 81% higher among those women with fibroids compared to those without.
• At 10 years, more than 5.4% of women with fibroids had experienced a cardiovascular event compared to 3% of women without fibroids.
• Women diagnosed with uterine fibroids were at increased heart disease risk across all racial and ethnic groups (white, Black, Hispanic and Asian groups).
• Among younger women, under age 40, the risk for cardiovascular disease was 251% higher (or more than 3.5 times more likely) in those with fibroids compared to those without fibroids.

“The strength of the relationship between heart disease risk and uterine fibroids was striking,” DiTosto said. “However, it's important to note that more research is needed to confirm these findings in other populations before formal changes are made to cardiovascular risk assessment guidelines. In the meantime, these results support having thoughtful conversations between women and their providers about heart health in the context of a fibroid diagnosis.”

“This study highlights yet another aspect in the unique factors that impact women in regard to the leading cause of death among them — cardiovascular disease,” said Stacey E. Rosen, M.D., FAHA, volunteer president of the American Heart Association and senior vice president of women’s health and executive director of the Katz Institute for Women’s Health of Northwell Health in New York City. “It also is an opportunity to recognize the very important role all of a woman’s health care clinicians can play in her overall health, including heart health. Because many women may use annual “well-woman” visits to their gynecologist or their general practitioner as their primary point of care, these visits offer exceptional opportunities that go beyond gynecologic health. These findings linking fibroids to heart disease support the need to discuss the bigger picture that considers ways to identify and reduce cardiovascular disease risk, even among those women who may not have any other apparent risk factors.”

Among the limitations of the study, fibroids may not have been diagnosed yet in women included in the comparison group. While the researchers tried to account for possible underdiagnosis of fibroids, the limitation may have impacted the results to some extent.

Reference:

Julia D. DiTosto, Jennifer Lewey, Jarcy Zee, Association Between Uterine Fibroids and Risk of Atherosclerotic Cardiovascular Disease, Journal of the American Heart Association, https://doi.org/10.1161/JAHA.125.044014