ASSOCIATION OF ENDOMETRIOSIS WITH CARDIOVASCULAR EVENTS THE ROLE OF SYSTEMIC INFLAMMATION AND GONADOTROPIN RELEASING HORMONETHERAPY

Abstract

The aim of the study was to evaluate the association of endometriosis in women of reproductive age with cardiovascular events, as well as to analyze the role of systemic inflammation and gonadotropin-releasing hormone (GnRH) agonist therapy.A single-center observational study was conducted that included 110 patients with laparoscopically confirmed endometriosis who were treated in a Novosibirsk hospital. Clinical and demographic characteristics, traditional cardiovascular risk factors, history of cardiovascular events, levels of highly sensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), as well as the presence and duration of GnRHagonist therapy were evaluated. The primary endpoint was a combined indicator, including myocardial infarction, ischemic stroke, transient ischemic attacks, episodes of unstable angina and hospitalization for hypertension decompensation. Cardiovascular events were reported in some patients and were associated with an older age, an increased body mass index, a higher incidence of hypertension, and more pronounced systemic inflammation in terms of hs-CRP, IL-6, and TNF-α levels. GnRH agonist therapy, especially with a duration of ≥ 6 months, was associated with an increased incidence of cardiovascular events. In a multivariate logistic regression, increased hs-CRP and long-term GnRHagonist therapy maintained an independent association with cardiovascular events after adjusting for age, body mass index, and hypertension. The results obtained emphasize the importance of endometriosis as a condition associated with increased cardiovascular risk, and indicate the important role of systemic inflammation and hormone therapy in the formation of an unfavorable cardiovascular profile in women of reproductive age. A comprehensive interdisciplinary approach involving a gynecologist and a cardiologist, early risk stratification and individualization of therapy are needed.