Endometriosis and cardiovascular disease risk: a meta-analysis of cohort studies

Objectives This meta-analysis aimed to evaluate the association between endometriosis (EM) and cardiovascular disease (CVD) risk by synthesizing evidence from large-scale cohort studies, with emphasis on subtype-specific risks and geographic disparities.Methods We systematically searched PubMed, Embase, and Cochrane Library for cohort studies published until December 2024. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using random-effects models. Subgroup analyses stratified CVD subtypes (e.g. ischemic heart disease, atrial fibrillation), continents, and country development levels. Heterogeneity and publication bias were assessed via I2 statistics, sensitivity analyses, and Egger’s test.Results Eleven cohort studies (n = 3,100,610 participants) were included. EM was associated with a 22% increased risk of all-cause CVD (HR = 1.22; 95% CI: 1.08–1.38; I2 = 94.6%). Subgroup analyses revealed elevated risks for myocardial infarction (HR = 1.29; 95% CI: 1.10–1.50), coronary artery disease (HR = 1.47; 95% CI: 1.29–1.67), and cerebrovascular events (HR = 1.18; 95% CI: 1.12–1.25), but not heart failure. Geographic disparities were significant, with higher CVD risks in Asian (HR = 1.36; 95% CI: 1.25–1.48) and North American cohorts (HR = 1.37; 95% CI: 1.16–1.61) compared to European populations (HR = 0.93; 95% CI: 0.64–1.34).Conclusions EM is independently associated with an elevated risk of CVD, particularly for coronary artery disease and myocardial infarction. These findings underscore the need for targeted cardiovascular monitoring in EM patients, particularly in high-risk populations.