Endometriosis Diagnosis and Subtypes, Reproductive History, and Cardiovascular Disease

项目总结 子宫内膜异位症负担约11%的妇女和心血管疾病(CVD)是导致死亡的主要原因 在美国女性中。有子宫内膜异位症病史的女性患慢性病的风险可能会增加， 包括由于更高的炎症水平，更高的高血压风险和更高的 高脂血症。一些研究表明，患冠心病和脑血管疾病的风险更高 对于那些患有子宫内膜异位症的人；然而，研究一直受到短期随访(10年)或较小规模的限制， 横断面设计。此外，以前的研究没有纳入关于子宫内膜异位症亚型的信息 或生育史(即不孕不育、不良妊娠结局)，所有这些都可能改变心血管疾病的风险。因此， 关于子宫内膜异位症和子宫内膜异位症之间的复杂联系，我们的认识存在显著差距。 心血管疾病。拟议的研究将利用来自两个现有队列的数据-一个表型良好的研究队列 嵌入到一个具有代表性的大型人群队列中-调查 子宫内膜异位症与临床和亚临床心血管疾病的风险。具体地说，我们将分析犹他州的数据 人口数据库(人口队列)和NICHD Endo研究(研究队列)。人口 队列包括电子健康记录和8万名匹配的子宫内膜异位症女性的生命统计数据 1：5按出生年份和出生地计算，无子宫内膜异位症病史，并有长达32年的随访期 以促进临床脑血管病的发展。研究队列由506名女性组成，她们被评估 在2007至2009年间，有184名妇女被诊断为子宫内膜异位症。参赛者： NICHD Endo研究将重新联系并筛查心血管疾病危险因素和亚临床心血管疾病标记物 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妇女是否有更高的心血管综合结局风险，以及 综合心血管结果的组成部分，包括突发心血管事件、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与无 子宫内膜异位症病史(目标1)。我们还将确定综合心血管疾病结局的风险和 根据子宫内膜异位症亚型(深层浸润型、子宫内膜瘤、浅表型)的不同而不同(目标2)。通过我们的远藤 后续研究我们将确定子宫内膜异位症是否会增加亚临床心血管疾病的风险，以心血管疾病风险衡量。 与非子宫内膜异位症患者(目标3)进行评分、心脏CT扫描和脑核磁共振成像比较。最后，我们会 确定子宫内膜异位症是否在青壮年动脉粥样硬化特征与中年心血管疾病之间的关系中起中介作用 (目标4)。拟议的项目为严格研究子宫内膜异位症提供了一个前所未有的机会。 临床和亚临床心血管疾病的风险，以及女性潜在的心血管疾病易感性在 子宫内膜异位症与心血管疾病的联系。我们的研究结果可能有助于为妇女的职业健康指南提供参考 子宫内膜异位症患者心血管危险因素的预防、筛查、早期发现和治疗。

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.