title: Uterine fibroids and cardiovascular risk.
abstract: Are uterine fibroids associated with increased cardiovascular risk?
  
  
  
  This study reports an association between increased serum lipids and metabolic syndrome with an increased risk of uterine fibroids.
  
  
  
  Recent studies suggest similarities in biological disease mechanisms and risk factors for fibroids and atherosclerosis: obesity, hypertension and abnormal serum lipids. These findings are awaiting confirmation that a population-based follow-up study could offer with extensive health examination data collection linked with a national hospital discharge register.
  
  
  
  The Northern Finland Birth Cohort (NFBC1966) is a population-based long-term follow-up study including all children with estimated date of delivery in 1966 in the Northern Finland area. The data were collected from national registries, postal questionnaires and clinical health examinations. The study population for this study comprised all females included in the NFBC1966 that underwent an extensive clinical health examination at age 46 years (n = 3635).
  
  
  
  All females included in the NFBC1966 who were alive and traceable (n = 5118) were invited for the 46-year follow-up study; 3268 (63.9%) responded, returned the postal questionnaire and attended the clinical examination. Uterine fibroid cases were identified through the national hospital discharge register that has data on disease diagnoses based on WHO ICD-codes. Uterine fibroid codes, ICD-9: 218 and ICD-10: D25 were used for case identification. Self-reported fibroid cases were identified through the postal questionnaire.
  
  
  
  A total of 729 fibroid cases were identified, including 293 based on hospital discharge registries. With adjustment for BMI, parity, education and current use of exogenous hormones the risk of prevalent fibroids rose significantly for every 1 mmol/l increase in LDL (OR = 1.13, 95% CI: 1.02-1.26 for all cases) and triglycerides (OR = 1.27, 95% CI: 1.09-1.49 for all cases). Metabolic syndrome associated with hospital discharge-based fibroid diagnosis (OR = 1.48, 95% CI: 1.09-2.01). Additionally every 1 unit increase in waist-hip ratio associated with fibroids (OR = 1.32, 95% CI: 1.10-1.57).
  
  
  
  The case ascertainment may present some limitations. There was likely an under-identification of cases and misclassification of some cases as controls; this would have diluted the effects of reported associations. The data analysed were cross-sectional and therefore cause and effect for the associations observed cannot be distinguished.
  
  
  
  Increased serum lipids and metabolic syndrome are associated with increased risk of uterine fibroids. Along with central obesity these findings add to an increased risk for cardiovascular disease among women with fibroids. These observations may suggest that there are shared predisposing factors underlying both uterine fibroids and adverse metabolic and cardiac disease risk, or that metabolic factors have a role in biological mechanisms underlying fibroid development.
  
  
  
  This study was supported by the Academy of Finland, University Hospital Oulu, University of Oulu, Finland, Northern Finland Health Care Foundation, Duodecim Foundation, ERDF European Regional Development Fund-Well-being and health: Research in the Northern Finland Birth Cohort 1966. The authors declare no conflict of interest.
authors.affiliation: Department of Obstetrics and Gynaecology, Oulu University Hospital, PO Box 5000, 90014 Oulu, Finland outi.uimari@oulu.fi.|PEDEGO Research Unit, University of Oulu and Oulu University Hospital, PO Box 5000, 90014 Oulu, Finland.|Medical Research Center Oulu, University of Oulu and Oulu University Hospital, PO Box 5000, 90014 Oulu, Finland.|Endometriosis CaRe Centre, Nuffield Department of Obstetrics and Gyneacology, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK.|Wellcome Trust Centre for Human Genetics, University of Oxford, Roosevelt Drive, Oxford OX3 7BN, UK.
authors.forename: Outi
authors.initials: O
authors.lastname: Uimari
authors.affiliation: Center for Life Course Health Research, University of Oulu, PO Box 8000, 90014 Oulu, Finland.|Unit of Primary Care, Oulu University Hospital, PO Box 5000, 90014 Oulu, Finland.
authors.forename: Juha
authors.initials: J
authors.lastname: Auvinen
authors.affiliation: Center for Life Course Health Research, University of Oulu, PO Box 8000, 90014 Oulu, Finland.|Unit of Primary Care, Oulu University Hospital, PO Box 5000, 90014 Oulu, Finland.
authors.forename: Jari
authors.initials: J
authors.lastname: Jokelainen
authors.affiliation: Medical Research Center Oulu, University of Oulu and Oulu University Hospital, PO Box 5000, 90014 Oulu, Finland.|NordLab Oulu, Department of Clinical Chemistry, University Hospital of Oulu, University of Oulu, PO Box 5000, 90014 Oulu, Finland.
authors.forename: Katri
authors.initials: K
authors.lastname: Puukka
authors.affiliation: Medical Research Center Oulu, University of Oulu and Oulu University Hospital, PO Box 5000, 90014 Oulu, Finland.|NordLab Oulu, Department of Clinical Chemistry, University Hospital of Oulu, University of Oulu, PO Box 5000, 90014 Oulu, Finland.
authors.forename: Aimo
authors.initials: A
authors.lastname: Ruokonen
authors.affiliation: Center for Life Course Health Research, University of Oulu, PO Box 8000, 90014 Oulu, Finland.|Unit of Primary Care, Oulu University Hospital, PO Box 5000, 90014 Oulu, Finland.
authors.forename: Marjo-Riitta
authors.initials: MR
authors.lastname: Järvelin
authors.affiliation: Department of Obstetrics and Gynaecology, Oulu University Hospital, PO Box 5000, 90014 Oulu, Finland.|PEDEGO Research Unit, University of Oulu and Oulu University Hospital, PO Box 5000, 90014 Oulu, Finland.|Medical Research Center Oulu, University of Oulu and Oulu University Hospital, PO Box 5000, 90014 Oulu, Finland.
authors.forename: Terhi
authors.initials: T
authors.lastname: Piltonen
authors.affiliation: Center for Life Course Health Research, University of Oulu, PO Box 8000, 90014 Oulu, Finland.|Unit of Primary Care, Oulu University Hospital, PO Box 5000, 90014 Oulu, Finland.
authors.forename: Sirkka
authors.initials: S
authors.lastname: Keinänen-Kiukaanniemi
authors.affiliation: Endometriosis CaRe Centre, Nuffield Department of Obstetrics and Gyneacology, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK.|Wellcome Trust Centre for Human Genetics, University of Oxford, Roosevelt Drive, Oxford OX3 7BN, UK.
authors.forename: Krina
authors.initials: K
authors.lastname: Zondervan
authors.affiliation: Department of Obstetrics and Gynaecology, Oulu University Hospital, PO Box 5000, 90014 Oulu, Finland.|PEDEGO Research Unit, University of Oulu and Oulu University Hospital, PO Box 5000, 90014 Oulu, Finland.|Medical Research Center Oulu, University of Oulu and Oulu University Hospital, PO Box 5000, 90014 Oulu, Finland.
authors.forename: Ilkka
authors.initials: I
authors.lastname: Järvelä
authors.affiliation: Department of Obstetrics and Gynaecology, Oulu University Hospital, PO Box 5000, 90014 Oulu, Finland.|PEDEGO Research Unit, University of Oulu and Oulu University Hospital, PO Box 5000, 90014 Oulu, Finland.|Medical Research Center Oulu, University of Oulu and Oulu University Hospital, PO Box 5000, 90014 Oulu, Finland.
authors.forename: Markku
authors.initials: M
authors.lastname: Ryynänen
authors.affiliation: Department of Obstetrics and Gynaecology, Oulu University Hospital, PO Box 5000, 90014 Oulu, Finland.|PEDEGO Research Unit, University of Oulu and Oulu University Hospital, PO Box 5000, 90014 Oulu, Finland.|Medical Research Center Oulu, University of Oulu and Oulu University Hospital, PO Box 5000, 90014 Oulu, Finland.
authors.forename: Hannu
authors.initials: H
authors.lastname: Martikainen
mesh_terms: D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology*; D003430:Cross-Sectional Studies; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D007889:Leiomyoma / Q000097:blood / Q000150:complications* / Q000453:epidemiology; D008055:Lipids / Q000097:blood*; D024821:Metabolic Syndrome / Q000097:blood / Q000150:complications*; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D014594:Uterine Neoplasms / Q000097:blood / Q000150:complications*; D049629:Waist-Hip Ratio
chemical_list: D008055:Lipids
keywords: cardiovascular risk; epidemiology; glucose metabolism; lipid metabolism; population-based birth cohort studies; uterine fibroids