Cardiovascular Disease (CVD) Risk in Women With Endometriosis: A Comprehensive Meta‐Analysis

BACKGROUND: Cardiovascular disease (CVD) remains the leading cause of mortality globally. Emerging evidence indicates that cardiovascular risk in women is frequently underestimated, underscoring the importance of recognizing sex-specific contributors. Endometriosis is a chronic inflammatory disorder affecting 5%-10% of reproductive-aged women. However, previous syntheses evaluating its cardiovascular implications have yielded inconsistent results or were narrow in scope. METHODS: A systematic literature search was conducted across databases, adhering to PRISMA guidelines. Studies comparing cardiovascular outcomes in women with versus without endometriosis were included. Primary outcomes were overall CVD and major adverse cardiovascular events (MACE). Secondary outcomes included ischemic heart disease (IHD), coronary artery disease (CAD), heart failure (HF), arrhythmias, coronary revascularization, and a composite of angina/acute myocardial infarction (Angina-AMI). Random-effects models with inverse variance weighting were used to calculate risk ratios (RRs) and 95% confidence intervals (CIs). RESULTS: Women with endometriosis exhibited a significantly higher risk of primary outcomes, including overall CVD (RR 1.21; 95% CI 1.09-1.35; p = 0.004) and MACE (RR 1.23; 95% CI 1.10-1.38; p = 0.01). Regarding secondary outcomes, endometriosis was significantly associated with elevated risks of IHD (RR 1.57; 95% CI 1.14-2.17; p = 0.01), CAD (RR 1.36; 95% CI 1.32-1.41; p < 0.0001), and Angina-AMI (RR 1.62; 95% CI 1.18-2.21; p = 0.002). Moderate-to-high statistical heterogeneity was observed across most secondary endpoints, except for CAD. CONCLUSION: Endometriosis is significantly associated with an increased risk of overall CVD, MACE, and ischemic coronary complications. These findings suggest that endometriosis should be recognized as an important sex-specific modifier of cardiovascular risk.