We only recently reviewed in these pages one of the most consequential medical condition for female fertility, endometriosis. One of the issues we addressed was the association of endometriosis with autoimmunity and, therefore, inflammation. Now a study, concluding that women with endometriosis demonstrate significantly increased cardiovascular risks, was published by Boston-based investigators, who utilized patient data from the “Nurses Health Study” conducted in Massachusetts between 1989 and 2009 (senior author Stacey A. Missmer, Sc.D., Director of Epidemiological Research in Reproductive Medicine, Brigham and Women’s Hospital, Boston, MA).
Increased risks with endometriosis include more myocardial infarctions, more coronary stenting procedures and coronary bypass surgeries. Particularly worrisome, those increased risks were most pronounced in women under age 40 who, of course, represent the primary patient populations of most fertility centers.
We always emphasize that association does not automatically mean causation. Nobody, even after the publication of this study, can state with certainty that endometriosis causes increased cardiovascular risks. However, this association is so very troubling exactly because such a causal relationship in this case makes so much pathophysiological sense.
Endometriosis is now well recognized as a condition characterized by significant chronic inflammation. Whether these inflammatory processes are primary or secondary to autoimmunity associated with this conditions is really of minor importance because some of the immunological pathways involved in chronic inflammation have already in other medical conditions been associated with increased cardiovascular risks.
A good example is the classical polycystic ovary syndrome (PCOS), characterized by trunkal obesity, hyperandrogenism and the metabolic syndrome. Like endometriosis, PCOS has in recent years increasingly been defined as an inflammatory condition. Because of its association with the metabolic syndrome, PCOS has for years also been considered a cardiovascular risk factor.
Endometriosis and PCOS are the two most common causes of female infertility. Both are now well recognized to represent chronic inflammatory conditions and both have been reported to be associated with increased prevalence of autoimmunity. And, as this new study out of Boston now demonstrates, both increase cardiovascular risks in women. How much more evidence is needed to convince our colleagues in reproductive medicine to pay more attention to the female immune system when treating female infertility!
This is a part of the April 2016 issue of the CHR VOICE.