Article Figures & Tables
Figures
- Figure 1:
Creation of study cohort. Note: CVD = cardiovascular disease, OHIP = Ontario Health Insurance Plan.
- Figure 2:
Incidence per 100 000 person-years and hazard ratios (HRs) for hospital admission for cardiovascular disease (CVD), in-hospital CVD events and CVD-related emergency department (ED) visits among females with endometriosis (exposed) and those without endometriosis (unexposed). Note: CI = confidence interval, Ref. = reference.
- Figure 3:
Cumulative incidence estimates of (A) hospital admission for cardiovascular disease (CVD), (B) in-hospital CVD events and (C) CVD-related emergency department (ED) visits among females with endometriosis (exposed) and those without endometriosis (unexposed). The Gray test showed significant differences for all outcomes (p < 0.0001).
- Figure 4:
Hazard ratios (HRs) comparing females with endometriosis (exposed) and those without endometriosis (unexposed) by age group for (A) hospital admission for cardiovascular disease (CVD), (B) in-hospital CVD events and (C) CVD-related emergency department (ED) visits. Note: CI = confidence interval.
Tables
Characteristic No. (%) of patients* Standardized difference With endometriosis
n = 166 853Without endometriosis
n = 333 706Age, yr, mean ± SD 36.4 ± 8.0 36.4 ± 8.0 0 Income quintile Q1 (lowest) 31904 (19.1) 64631 (19.4) 0.006 Q2 33899 (20.3) 65962 (19.8) 0.014 Q3 34446 (20.6) 67767 (20.3) 0.008 Q4 35030 (21.0) 68629 (20.6) 0.011 Q5 (highest) 31153 (18.7) 65824 (19.7) 0.027 Rural residence 21282 (12.8) 42559 (12.8) 0 Immigrant 22898 (13.7) 48478 (14.5) 0.023 Nulliparity 108964 (65.3) 198877 (59.6) 0.118 Comorbidities at index date Obesity 16124 (9.7) 27780 (8.3) 0.047 Diabetes 4576 (2.7) 7803 (2.3) 0.026 Hypertension 12937 (7.8) 18799 (5.6) 0.085 Pelvic pain 66102 (39.6) 52519 (15.7) 0.554 Fibroids 32950 (19.7) 11388 (3.4) 0.528 Infertility 40766 (24.4) 28881 (8.7) 0.435 Premature menopause 18298 (11.0) 17171 (5.1) 0.215 Surgical history at index Bilateral oophorectomy 15978 (9.6) 1549 (0.5) 0.427 Hysterectomy 46710 (28.0) 7660 (2.3) 0.768 Endometriosis characteristics Index year 1993–1999 64628 (38.7) 129256 (38.7) 0 2000–2007 58818 (35.3) 117636 (35.3) 0 2008–2015 43407 (26.0) 86814 (26.0) 0 Method of diagnosis Medical only 25920 (15.5) NA NA Surgical at any time 140933 (84.5) NA NA Note: NA = not applicable, SD = standard deviation.
↵* Unless indicated otherwise.
Characteristic* No. (%) of patients† Standardized difference With endometriosis
n = 166 853Without endometriosis
n = 333 706Death before study end 4125 (2.5) 8224 (2.5) 0 Comorbidities Diabetes diagnosis at any time 19900 (11.9) 32951 (9.9) 0.085 Hypertension diagnosis at any time 45151 (27.1) 74798 (22.4) 0.108 Pelvic pain at any time 93149 (55.8) 88832 (26.6) 0.621 Pelvic pain in follow-up 55487 (33.3) 48686 (14.6) 0.448 Fibroids at any time 48642 (29.2) 34587 (10.4) 0.486 Fibroids in follow-up 26832 (16.1) 26428 (7.9) 0.253 Surgical history Hysterectomy at any time 77828 (46.6) 25212 (7.6) 0.979 Bilateral oophorectomy at any time 32503 (19.5) 9083 (2.7) 0.554 Menopause history Menopause diagnosis at any time 72076 (43.2) 99149 (29.7) 0.283 Premature menopause diagnosis at any time 40903 (24.5) 32698 (9.8) 0.398 Age at menopause diagnosis, yr, mean ± SD 42.97 ± 7.62 46.18 ± 7.75 0.418 Menopause diagnosis or bilateral oophorectomy at any time 81537 (48.9) 102313 (30.7) 0.379 - Table 3:
Cardiovascular disease–related outcomes among patients with and without endometriosis
Outcome No. (%) of patients Standardized difference IRR (95% CI) With endometriosis
n = 166 853Without endometriosis
n = 333 706Primary composite: hospital admission for CVD 4652 (2.8) 7586 (2.3) 0.033 1.20 (1.15–1.24) Acute MI 1370 (0.8) 2366 (0.7) 0.013 1.13 (1.05–1.20) Stroke 970 (0.6) 1706 (0.5) 0.01 1.11 (1.02–1.20) Congestive heart failure 636 (0.4) 1,141 (0.3) 0.007 1.09 (0.99–1.20) Percutaneous coronary intervention 1186 (0.7) 2034 (0.6) 0.013 1.14 (1.06–1.22) Coronary artery bypass graft 324 (0.2) 585 (0.2) 0.004 1.08 (0.94–1.23) Ischemic heart disease 3150 (1.9) 5005 (1.5) 0.03 1.23 (1.17–1.28) Cerebrovascular disease 1317 (0.8) 2216 (0.7) 0.015 1.16 (1.08–1.24) Secondary composite: in-hospital CVD events 6929 (4.2) 10 378 (3.1) 0.056 1.31 (1.27–1.35) Cardiac catheterization 5290 (3.2) 7566 (2.3) 0.056 1.37 (1.32–1.42) Unstable angina 850 (0.5) 1198 (0.4) 0.023 1.38 (1.27–1.51) Ischemic stroke 680 (0.4) 1119 (0.3) 0.012 1.18 (1.08–1.30) Hemorrhagic stroke 331 (0.2) 650 (0.2) 0.001 0.99 (0.87–1.13) Transient ischemic attack 218 (0.1) 332 (0.1) 0.009 1.28 (1.08–1.52) Atrial fibrillation 787 (0.5) 1323 (0.4) 0.011 1.16 (1.06–1.26) Abdominal aortic aneurysm 21 (0.0) 32 (0.0) 0.003 1.28 (0.74–2.21) Peripheral artery disease 175 (0.1) 370 (0.1) 0.002 0.92 (0.77–1.10) Stent 74 (0.0) 151 (0.0) 0 0.95 (0.72–1.26) CVD-related emergency department visits 4998 (5.1) 7233 (3.7) 0.069 1.35 (1.30–1.40) Note: CI = confidence interval, CVD = cardiovascular disease, IRR = incidence rate ratio, MI = myocardial infarction.
Outcome Incidence per 100 000 person-years (95% CI) Adjusted HR (95% CI) Primary composite: hospital admission for CVD Medical diagnosis 144.84 (132.26–158.63) 1.14 (1.04–1.25) Surgical diagnosis 202.72 (196.71–208.91) 1.14 (1.10–1.19) Secondary composite: in-hospital CVD events Medical diagnosis 213.42 (198.01–230.03) 1.22 (1.13–1.32) Surgical diagnosis 304.61 (297.22–312.18) 1.27 (1.23–1.31) CVD-related emergency department visits Medical diagnosis 513.20 (479.72–549.02) 1.47 (1.37–1.58) Surgical diagnosis 508.68 (493.51–524.32) 1.27 (1.22–1.32) Note: CI = confidence interval, CVD = cardiovascular disease, HR = hazard ratio.
- Table 5:
Hazard ratios comparing females with endometriosis (exposed) versus those without endometriosis (unexposed)
Age group HR (95% CI) Hospital admission for CVD In-hospital CVD events CVD-related emergency department visits ≤ 30 yr 1.73 (1.50–2.00) 1.74 (1.54–1.96) 1.87 (1.70–2.06) 30–34 yr 1.12 (1.00–1.26) 1.39 (1.27–1.53) 1.32 (1.19–1.46) 35–39 yr 1.26 (1.16–1.37) 1.34 (1.25–1.43) 1.37 (1.26–1.49) 40–44 yr 1.19 (1.11–1.28) 1.30 (1.23–1.38) 1.20 (1.12–1.29) 45–50 yr 0.98 (0.92–1.05) 1.10 (1.04–1.17) 1.15 (1.07–1.24) ≥ 50 yr 0.92 (0.78–1.08) 1.04 (0.91–1.19) 0.93 (0.77–1.13) Note: CI = confidence interval, CVD = cardiovascular disease, HR = hazard ratio.
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