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Cardiometabolic Risk Factors and Benign Gynecologic Disorders

AlAshqar, Abdelrahman MD*,†; Patzkowsky, Kristin MD; Afrin, Sadia PhD§; Wild, Robert MD, PhD, MPH; Taylor, Hugh S. MD; Borahay, Mostafa A. MD, PhD**

Obstetrical & Gynecological Survey: November 2019 - Volume 74 - Issue 11 - p 661–673
doi: 10.1097/OGX.0000000000000718

Importance While it has long been known that polycystic ovarian syndrome is associated with cardiometabolic risk factors (CMRFs), there is emerging evidence that other benign gynecologic conditions, such as uterine leiomyomas, endometriosis, and even hysterectomy without oophorectomy, can be associated with CMRFs. Understanding the evidence and mechanisms of these associations can lead to novel preventive and therapeutic interventions.

Objective This article discusses the evidence and the potential mechanisms mediating the association between CMRFs and benign gynecologic disorders.

Evidence Acquisition We reviewed PubMed, EMBASE, Scopus, and Google Scholar databases to obtain plausible clinical and biological evidence, including hormonal, immunologic, inflammatory, growth factor–related, genetic, epigenetic, atherogenic, vitamin D–related, and dietary factors.

Results Cardiometabolic risk factors appear to contribute to uterine leiomyoma pathogenesis. For example, obesity can modulate leiomyomatous cellular proliferation and extracellular matrix deposition through hyperestrogenic states, chronic inflammation, insulin resistance, and adipokines. On the other hand, endometriosis has been shown to induce systemic inflammation, thereby increasing cardiometabolic risks, for example, through inducing atherosclerotic changes.

Conclusion and Relevance Clinical implications of these associations are 2-fold. First, screening and early modification of CMRFs can be part of a preventive strategy for uterine leiomyomas and hysterectomy. Second, patients diagnosed with uterine leiomyomas or endometriosis can be screened and closely followed for CMRFs and cardiovascular disease.

Target Audience Obstetricians and gynecologists, family physicians.

Learning Objectives After participating in this activity, the learner should be better able to identify the association between cardiometabolic risk factors and benign gynecologic disorders; explain the potential underlying mechanisms of such association; and discuss their clinical implications on health and health care.

*Visitor, Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD

Physician, Department of Obstetrics and Gynecology, Kuwait University, Kuwait City, Kuwait

Assistant Professor

§Postdoctoral Fellow, Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD

Professor, Department of Obstetrics and Gynecology, Oklahoma University, Oklahoma City, OK

Professor, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University, New Haven, CT

**Associate Professor, Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD

All authors, faculty, and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations relevant to this educational activity.

This work was supported, in part, by National Institutes of Health grant 1R01HD094380-01 to M.A.B.

Correspondence requests to: Mostafa A. Borahay, MD, PhD, Department of Gynecology and Obstetrics, Johns Hopkins University, 4940 Eastern Ave, Baltimore, MD 21224. E-mail:

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