Endometriosis and the Silent Heart Risk: A Systematic Review of Cardiovascular Disease in Affected Women

Abstract

Endometriosis affects approximately 10% of reproductive-aged women worldwide and is increasingly recognized as a chronic systemic inflammatory condition that may contribute to cardiovascular disease (CVD). We conducted a PRISMA 2020–guided systematic review to evaluate the association between endometriosis and cardiovascular outcomes. We searched PubMed (Medline), Embase, Scopus, and Web of Science for observational studies and meta-analyses published between January 2000 and May 2025, with emphasis on evidence from 2019–2025. Eligible studies compared cardiovascular outcomes in women with clinically or surgically diagnosed endometriosis versus women without endometriosis. Outcomes included myocardial infarction, ischemic heart disease, stroke, hypertension, arrhythmias, heart failure, atherosclerotic markers, and venous thromboembolism. Two reviewers independently screened records, extracted data, and assessed study quality following PRISMA guidance. Large cohort studies and recent meta-analyses consistently demonstrate higher cardiovascular risk among women with endometriosis. Adjusted hazard ratios reported in primary studies ranged from 1.12 for new-onset hypertension to 1.52 for coronary artery disease. Meta-analyses including over 1.4 million women reported pooled hazard ratios of ~1.35 for ischemic heart disease and ~1.19 for cerebrovascular disease. Subclinical studies show impaired endothelial function and increased markers of early atherosclerosis in women with endometriosis. Endometriosis is associated with a modest but consistent increase in risk of several cardiovascular outcomes across diverse populations and study designs. These findings support systematic cardiovascular risk assessment and appropriate preventive strategies in women with endometriosis.