Women with Non-Malignant Gynecological Diseases Face Increased Cardiovascular and Cerebrovascular Risk: Study Finds

"Non-malignant gynecological diseases were linked to a 28% higher risk of cardiovascular or cerebrovascular disease (SRR = 1.28). The risk was even more pronounced for ischemic heart disease, with a 41% increase, especially in individuals with endometriosis and polycystic ovary syndrome," the researchers reported in the BMJ Journal Heart. These findings highlight the importance of cardiovascular risk assessment in women with NMGDs.

The researchers note that cardiovascular disease remains the leading cause of death worldwide. Non-malignant gynecological diseases impact overall health and well-being and contribute to an increased risk of cardiovascular or cerebrovascular disease, emphasizing the need for further investigation into this potential association. To fill this knowledge gap, Giorgia Elisabeth Colombo, Department of Obstetrics and Gynecology, Ospedale Regionale di Lugano, Lugano, Switzerland, and colleagues aimed to compile all available epidemiological studies on the link between chronic NMGD and C/CVD. As the first meta-analysis on this association, it offers novel and comprehensive insights into the overall relationship and subgroup-specific risks.

For this purpose, the researchers conducted a comprehensive search across seven databases for relevant studies up to April 21, 2024. They included observational studies that reported risk estimates for the association between NMGD and C/CVD. Two independent reviewers extracted the data, and random effects models were used to calculate the summary relative risk (SRR). The composite C/CVD outcome included ischemic heart disease, cerebrovascular disease, heart failure, and peripheral vascular disease. Study quality and risk of bias were assessed using the ROBINS-I tool.

Key Findings:

• A total of 6,639 studies were screened, out of which 59 were reviewed in full, and 28 were included in the final analysis, covering 3,271,242 individuals.
• More than half (53.5%) of the studies were assessed as having a ‘serious’ or ‘critical’ risk of bias.
• Individuals with NMGD had a significantly higher risk of composite C/CVD, with low heterogeneity among studies (SRR 1.28; n=16 studies, I²=65.3%).
• The risk of ischemic heart disease was elevated (SRR 1.41; n=21 studies, I²=73.7%).
• The likelihood of cerebrovascular disease was also increased (SRR 1.33; n=16 studies, I²=91.5%).
• Subgroup analyses revealed a higher risk of C/CVD and its components in individuals with a history of endometriosis or polycystic ovary syndrome.

The researchers found a significant association between NMGD and C/CVD across all studies, though individual estimates varied. They emphasized the need for rigorous study designs, better harmonization of NMGD and C/CVD definitions, and a deeper understanding of risk variations among subpopulations. Highlighting the clinical relevance, the researchers urged physicians to consider this association for early risk assessment and prevention strategies.

"Our findings emphasize the necessity of prospective longitudinal research to further evaluate these risks, which could drive the development of targeted primary prevention strategies and improve patient outcomes," they concluded.

Reference:

Colombo GE, Mahamat-Saleh Y, Armour M, Madan K, Sabag A, Kvaskoff M, Missmer SA, Condous G, Pathan F, Leonardi M. Non-malignant gynaecological disease and risk of cardiovascular or cerebrovascular disease: a systematic review and meta-analysis. Heart. 2025 Feb 24:heartjnl-2024-324675. doi: 10.1136/heartjnl-2024-324675. Epub ahead of print. PMID: 39993911.