Women’s Health
Endometriosis and midlife circulating biomarkers of inflammation and total cholesterol Leslie V. Farland* Leslie V. Farland William J. Degnan, III Holly R. Harris Kathryn M. Rexrode Stacey A. Missmer
Introduction: Mounting evidence suggests that women with endometriosis are at greater risk for cardiovascular disease (CVD). Endometriosis may influence CVD through a detrimental impact on circulating inflammatory biomarkers and lipids. However, there is a paucity of research on endometriosis and these biomarkers in midlife.
Methods: We used generalized linear models adjusted for potential confounding factors to determine the association between history of laparoscopically-confirmed endometriosis and log-transformed plasma C-reactive protein (CRP) (n=3,935), interleukin-6 (IL-6) (n=3,495), tumor necrosis factor-alpha (TNF-a) (n=2,967), high-density lipoprotein (HDL) (n=1,533), low-density lipoprotein (LDL) (n=1,324), and total cholesterol (n=4,898) among participants with existing blood measurements in the Nurses’ Health Study II. We investigated heterogeneity by body mass index (BMI; <25 kg/m2 vs. > 25 kg/m2), infertility history, parity, and history of gynecologic surgery (oophorectomy and/or hysterectomy).
Results: On average, participants were 44 years old at blood draw. We did not observe associations between endometriosis and inflammatory biomarkers (CRP % difference:-4.6, 95% CI [-15.7,7.8]; IL-6: -0.4% [-7.2,7.1]; TNF-a:-1.3% [-4.1,1.6]). Nor did we observe associations between endometriosis and HDL (0.8% [-3.7,5.6]), LDL (-0.2% [-5.2,5.0]), or total cholesterol (1.0% [-0.7,2.7]). However, the association between endometriosis and total cholesterol varied by BMI (P-value, test for heterogeneity:0.05). Among women with a BMI > 25 kg/m2, those with endometriosis had 2.7% higher total cholesterol (0.2,5.2) than those without endometriosis.
Discussion: History of endometriosis diagnosis was not associated with levels of inflammation, HDL, or LDL midlife. Endometriosis was modestly associated with total cholesterol among those with a BMI > 25 kg/m2. These findings suggest that endometriosis may be associated with CVD through other mechanisms