title: Endometriosis and Risk of Coronary Heart Disease.
abstract: Endometriosis is a prevalent gynecologic disease associated with systemic chronic inflammation, heightened oxidative stress, and atherogenic lipid profile that may increase women's risk for coronary heart disease (CHD).
  
  
  
  We examined the prospective association between laparoscopically confirmed endometriosis and subsequent CHD among 116 430 women in the Nurses' Health Study II (1989-2009). Participants with a history of heart disease and stroke were excluded. When compared with women without endometriosis, women with laparoscopically confirmed endometriosis had a higher risk of myocardial infarction (relative risk, 1.52; 95% confidence interval, 1.17-1.98), angiographically confirmed angina (1.91; 1.59-2.29), coronary artery bypass graft surgery/coronary angioplasty procedure/stent (1.35; 1.08-1.69), or any of these CHD end points combined (1.62; 1.39-1.89), independent of potential demographic, anthropometric, family history, reproductive, and lifestyle confounders. Relative risk for the combined CHD end point was highest among women aged ≤40 years (3.08; 2.02-4.70) and decreased as age increased (40< age ≤50 years, 1.65; 1.35-2.02; 50< age ≤55 years, 1.44; 1.07-1.94; and age >55 years, 0.98; 0.56-1.72; P value, test for heterogeneity=0.001). Having had a hysterectomy/oophorectomy was associated with higher risk of combined CHD compared with not having had a hysterectomy/oophorectomy (1.51; 1.34-1.71). A percentage of 42 of the association between endometriosis and CHD could be explained by greater frequency of hysterectomy/oophorectomy and earlier age at surgery after endometriosis diagnosis.
  
  
  
  In this large, prospective cohort, laparoscopically confirmed endometriosis was associated with increased risk of CHD. The association was strongest among young women. Hysterectomy/oophorectomy was associated with higher risk of CHD and could partially explain the association between endometriosis and CHD.
authors.affiliation: From the Department of Epidemiology (F.M., J.R.-E., E.B.R., D.S., S.A.M.), Department of Nutrition (E.B.R., D.S.), and Department of Biostatistics (D.S.), Harvard T.H. Chan School of Public Health, Boston, MA; Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, MA (J.R.-E.); Channing Division of Network Medicine, Department of Medicine (E.B.R., S.A.M.) and Department of Obstetrics, Gynecology, and Reproductive Biology (S.A.M.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA. fam434@mail.harvard.edu.
authors.forename: Fan
authors.initials: F
authors.lastname: Mu
authors.affiliation: From the Department of Epidemiology (F.M., J.R.-E., E.B.R., D.S., S.A.M.), Department of Nutrition (E.B.R., D.S.), and Department of Biostatistics (D.S.), Harvard T.H. Chan School of Public Health, Boston, MA; Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, MA (J.R.-E.); Channing Division of Network Medicine, Department of Medicine (E.B.R., S.A.M.) and Department of Obstetrics, Gynecology, and Reproductive Biology (S.A.M.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Janet
authors.initials: J
authors.lastname: Rich-Edwards
authors.affiliation: From the Department of Epidemiology (F.M., J.R.-E., E.B.R., D.S., S.A.M.), Department of Nutrition (E.B.R., D.S.), and Department of Biostatistics (D.S.), Harvard T.H. Chan School of Public Health, Boston, MA; Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, MA (J.R.-E.); Channing Division of Network Medicine, Department of Medicine (E.B.R., S.A.M.) and Department of Obstetrics, Gynecology, and Reproductive Biology (S.A.M.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Eric B
authors.initials: EB
authors.lastname: Rimm
authors.affiliation: From the Department of Epidemiology (F.M., J.R.-E., E.B.R., D.S., S.A.M.), Department of Nutrition (E.B.R., D.S.), and Department of Biostatistics (D.S.), Harvard T.H. Chan School of Public Health, Boston, MA; Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, MA (J.R.-E.); Channing Division of Network Medicine, Department of Medicine (E.B.R., S.A.M.) and Department of Obstetrics, Gynecology, and Reproductive Biology (S.A.M.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Donna
authors.initials: D
authors.lastname: Spiegelman
authors.affiliation: From the Department of Epidemiology (F.M., J.R.-E., E.B.R., D.S., S.A.M.), Department of Nutrition (E.B.R., D.S.), and Department of Biostatistics (D.S.), Harvard T.H. Chan School of Public Health, Boston, MA; Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, MA (J.R.-E.); Channing Division of Network Medicine, Department of Medicine (E.B.R., S.A.M.) and Department of Obstetrics, Gynecology, and Reproductive Biology (S.A.M.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Stacey A
authors.initials: SA
authors.lastname: Missmer
mesh_terms: D000328:Adult; D000367:Age Factors; D000787:Angina Pectoris / Q000453:epidemiology; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000453:epidemiology; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000628:therapy; D004715:Endometriosis / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects; D010535:Laparoscopy; D008137:Longitudinal Studies; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D009726:Nurses; D010052:Ovariectomy / Q000009:adverse effects; D062645:Percutaneous Coronary Intervention / Q000295:instrumentation; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: coronary artery disease; endometriosis; epidemiology