2023-08-20 15:17:10
Why is this important?
Endometriosis is an estrogen-dependent inflammatory disease that affects approximately 10% of women of childbearing age. Its etiology remains unknown to date. Early age of menstrual onset, short menstrual cycle length and thinness are the most frequently reported risk markers. Several chronic cardiometabolic diseases have been associated with endometriosis such as hypertension, hypercholesterolemia, subclinical atherosclerosis and myocardial infarction. This finding suggests that there is a common mechanism. Several studies have suggested that there may be an association between endometriosis and the risk of cardiometabolic disease. This review provides an update on the subject from a large prospective cohort.
Methodology
The E3N study is a prospective cohort of 98,995 French women aged 40 to 65 at inclusion. Analyzes explored the association between endometriosis and incident T2D. The effect was assessed by age, BMI, infertility treatment, adherence to the Mediterranean diet, and menopausal status.
Principle results
During a median follow-up of 16.1 years, 4,606 women out of the 83,582 included reported surgically confirmed endometriosis.
On inclusion, the mean age was 51(±6) years and a total of 2,268 incident cases of T2DM were observed, including 122 among women with confirmed endometriosis. The average age at diagnosis of T2D was 66.7 years. Women with a history of endometriosis were more likely than others to have a family history of diabetes (13.3% versus 10.2%), a personal history of hypertension (7.6% versus 6.4%), high cholesterol (7.9% versus 6.6%), to have had their first period early (<13 years: 50.1% versus 47.2%), to have had a bilateral oophorectomy (32.2% versus 9.2%), to have taken oral contraceptives (65.1% versus 59.7%) and to have a higher level of education (≥15 years: 36.0% versus 35.0%, p=0.017). There was no difference in Mediterranean diet adherence scores between those with a history of endometriosis and those without.
After adjusting for potential confounding factors such as age, BMI, physical activity, smoking, level of education, age at first menstrual period and use of oral contraceptives, endometriosis did not not been associated with the risk of T2D (Hazard ratio (HR) 1,09 [0,92-1,29]).
Moreover, the results were similar following additional adjustment for family history of diabetes, high blood pressure and menopausal status (HR 0.97 [0,80-1,16]).
Finally, the relationship did not differ either according to age at inclusion (<50 years or ≥50 years), nor BMI (<25 kg/m2 or ≥25 kg/m2), treatment infertility, diet or menopausal status.
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