Endometriosis Diagnosis and Subtypes, Reproductive History, and Cardiovascular Disease

项目摘要 子宫内膜异位症负担约11%的妇女和心血管疾病（CVD）是死亡的主要原因 在美国女性中。有子宫内膜异位症病史的女性患慢性疾病的风险可能会增加， 包括由于更高水平的炎症引起的CVD，高血压的风险更大， 高脂血症少数研究显示冠心病和脑血管疾病的风险更高 对于子宫内膜异位症患者;然而，研究受到随访时间短（<10年）或小的限制， 横截面设计此外，先前的研究没有纳入子宫内膜异位症亚型的信息 或生殖史（即，不孕症，不良妊娠结局），所有这些都可能改变CVD风险。因此，在本发明中， 关于子宫内膜异位症和子宫内膜异位症之间的复杂关系， CVD。拟议的研究将利用两个现有队列的数据-一个表型良好的研究队列 嵌入在一个大的代表性人口队列-调查之间的关系， 子宫内膜异位症与临床和亚临床CVD的风险。具体来说，我们将分析来自犹他州的数据 人群数据库（人群队列）和NICHD ENDO研究（研究队列）。人口 队列包括> 80，000名子宫内膜异位症匹配女性的电子健康记录和生命统计数据 1：5，按出生年份和出生地，无子宫内膜异位症病史的女性，随访时间长达32年 从而导致临床CVD的发展。研究队列包括506名接受评估的女性。 2007年至2009年期间，184名妇女被诊断患有子宫内膜异位症。参与者 将重新联系NICHD ENDO研究并筛选CVD风险因素和亚临床CVD标志物 在一次新的临床访问中。利用人口队列和研究队列，我们将确定 有子宫内膜异位症病史的女性是否有复合CVD结局的风险增加， 复合CVD结局的组成部分，包括偶发心血管事件、慢性高血压、 代谢综合征、2型糖尿病、血脂异常和慢性肾脏疾病的女性相比， 子宫内膜异位症病史（目的1）。我们还将确定复合CVD结局的风险和 复合物因子宫内膜异位症亚型（深浸润性、腺瘤、浅表性）而异（目的2）。通过我们的ENDO 随访研究我们将确定子宫内膜异位症是否会增加亚临床CVD的风险，通过CVD风险来衡量 评分、心脏CT扫描和脑MRI与无子宫内膜异位症的患者进行比较（目的3）。最后我们将 确定子宫内膜异位症是否介导年轻成人致动脉粥样硬化特征和中年CVD之间的关系 (Aim 4）。拟议的项目提供了一个前所未有的机会，严格调查子宫内膜异位症 和临床和亚临床CVD的风险，以及女性潜在的CVD易感性在 脑血管病与心血管疾病的联系我们的研究结果可能有助于为女性职业健康指南提供信息， 预防、筛查、早期发现和治疗子宫内膜异位症妇女的心血管疾病危险因素。

PROJECT SUMMARY Endometriosis burdens ~11% of women and cardiovascular disease (CVD) is the leading cause of mortality among US women. Women who have a history of endometriosis may be at increased risk of chronic diseases, including CVD due to higher levels of inflammation, greater risk of hypertension, and greater risk for hyperlipidemia. A few studies have shown higher risk of coronary heart disease and cerebrovascular disease for those with endometriosis; however, studies have been limited by short follow-up (<10 years) or small, cross-sectional design. In addition, prior studies have not incorporated information on endometriosis subtypes or reproductive history (i.e., infertility, adverse pregnancy outcomes), all of which may alter CVD risk. Thus, there are significant gaps in our knowledge regarding the complex association between endometriosis and CVD. The proposed research will leverage data from two existing cohorts—a well-phenotyped research cohort embedded within a large representative population cohort—to investigate the relationship between endometriosis and risk of clinical and subclinical CVD. Specifically, we will analyze data from the Utah Population Database (Population Cohort) and the NICHD ENDO study (Research Cohort). The Population Cohort comprises electronic health records and vital statistics of >80,000 women with endometriosis matched 1:5 by birth year and birthplace to women with no history of endometriosis and has up to 32 years of follow-up to allow for the development of clinical CVD. The Research Cohort comprises 506 women who were assessed for endometriosis between 2007 and 2009; 184 women were diagnosed with endometriosis. Participants in the NICHD ENDO study will be re-contacted and screened for CVD risk factors and subclinical CVD markers during a new clinical visit. Leveraging both the Population Cohort and the Research Cohort, we will determine whether women with a history of endometriosis have an increased risk of a composite CVD outcome, and components of composite CVD outcome, including incident cardiovascular events, chronic hypertension, metabolic syndrome, type 2 diabetes, dyslipidemia, and chronic kidney disease compared to women without a history of endometriosis (Aim 1). We will also determine if risk of composite CVD outcome and components of composite vary by endometriosis subtype (deep infiltrating, endometriomas, superficial) (Aim 2). Via our ENDO Follow-Up Study we will determine if endometriosis increases risk of subclinical CVD, measured by CVD risk scores, cardiac CT scans, and brain MRIs compared to those without endometriosis (Aim 3). Finally, we will determine if endometriosis mediates the relationship between young adult atherogenic profile and mid-life CVD (Aim 4). The proposed project provides an unprecedented opportunity to rigorously investigate endometriosis and risk for clinical and subclinical CVD, and the role that a woman’s underlying predisposition to CVD plays in the endometriosis–CVD link. Our study findings may help inform women’s professional health guidelines in the prevention, screening, early detection, and treatment of CVD risk factors among women with endometriosis.