Endometriosis, Infertility, and Risk of Stroke

项目摘要/摘要 子宫内膜异位症是一种慢性妇科疾病，其特征是炎症水平升高和异常。 子宫内膜样组织植入子宫外时产生的免疫功能。女性与 子宫内膜异位症的不孕症风险增加了两倍，诊断为子宫内膜异位症的患者占所有患者的20%-50% 不孕不育诊断。最近的研究表明，患有子宫内膜异位症的女性以及患有子宫内膜异位症的女性 不孕症在晚年患心血管疾病和其他慢性疾病的风险可能会增加。海流 然而，研究具有这些生殖因素的妇女的长期健康轨迹的方法已经 仅限于生育治疗的登记研究，随访时间短，细节不足 子宫内膜异位症。尽管中风对女性造成了不成比例的负担，但与中风相关的研究尤其不足 子宫内膜异位症和不孕症。此外，很少有研究调查子宫内膜异位症在子宫内膜异位症中的作用。 是否存在不孕症，这可能具有独立或协同的影响。我们的建议结合了 前瞻性收集了116,429名护士健康研究II参与者的大量表型数据 30年的随访和生物样本，以弥补现有文献中的这些空白。具体来说， 我们的建议将解决：1)子宫内膜异位症、不孕症和中风之间的关系(完全、出血、 和缺血性中风(目标1))；2)调查子宫内膜异位症、不孕症和 中风因绝经年龄和绝经过渡模式而异(目标2)； 子宫内膜异位症、不孕症和中风(抗苗勒氏激素)之间联系的潜在途径 炎症[白介素6和高敏C反应蛋白]、脂类[高密度脂蛋白，低密度脂蛋白] 密度脂蛋白，总胆固醇]和脂肪因子[瘦素，脂联素](目标3)。 严格和有效的机会调查子宫内膜异位症和不孕症作为中风风险的标志 女人。这一建议是了解子宫内膜异位症、不孕症、 和中风负担以及这些关联背后的机制，并将提供形成 未来对病因学、预防、管理和治疗的研究。

Project Summary/Abstract Endometriosis is a chronic gynecology disease characterized by increased levels of inflammation and aberrant immune function that occurs when endometrial-like tissue implants outside the uterus. Women with endometriosis are at a two-fold increased risk of infertility and endometriosis diagnoses represent 20-50% of all infertility diagnoses. Recent research has suggested that women with endometriosis as well as women with infertility may be at an increased risk of cardiovascular and other chronic diseases later in life. The current approach to studying the long-term health trajectory of women with these reproductive factors, however, has been limited to registry studies of fertility treatment with short durations of follow-up and insufficient details on endometriosis. Despite a disproportionate burden in women, stroke is particularly understudied in relation to endometriosis and infertility. Moreover, very few studies have investigated the role of endometriosis in the presence and absence of infertility, which may have independent or synergistic effects. Our proposal combines extensive phenotypic data from 116,429 participants in the Nurses' Health Study II collected prospectively over 30 years of follow-up as well as biologic samples to address these gaps in the existing literature. Specifically, our proposal will address: 1) the relationship between endometriosis, infertility, and stroke (total, hemorrhagic, and ischemic stroke (Aim 1)); 2) investigate whether the relationship between endometriosis, infertility, and stroke varies by age at menopause and mode of menopausal transition (Aim 2); and 3) the biological pathways underlying the association between endometriosis, infertility, and stroke (anti-mullerian hormone [AMH], inflammation [Interleukin-6 and high sensitivity-C Reactive Protein], lipids [high-density lipoprotein, low- density lipoprotein, total cholesterol] and adipokines [leptin, adiponectin](Aim 3)).These aims represent a rigorous and efficient opportunity to investigate endometriosis and infertility as a marker of risk of stroke in women. This proposal is a first-step toward understanding the association between endometriosis, infertility, and stroke burden and the mechanisms underlying these associations, and will provide insights that shape future research into etiology, prevention, management, and treatment.