Cardiometabolic Risk Factors and Benign Gynecologic Disorders

Abstract

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.

Narrative Literature Review on Risk Factors Involved In Breast Cancer, Brain Cancer, Colon Rectal Cancer, Gynecological Malignancy, Lung Cancer, and Prostate Cancer<strong> </strong>

“…A study was conducted with 1,917,430 individuals in Korea and established an association between PCA and obesity based on waist circumference. [2]. The study also explained why there are discrepancies in multiple studies that used body mass index solely to study the association between PCA and obesity.…”

Diet and Nutrition in Gynecological Disorders: A Focus on Clinical Studies

“…In brief, advanced glycation end products can induce DNA damage, which alongside hyperglycemia-induced ROS, epigenetic modulation, and oncoprotein upregulation, can initiate neoplastic transformation [ 22 ]. Similarly, obesity, by means of subclinical inflammation, creates an aberrant adipokine profile that promotes tumorigenesis of benign and malignant nature in women [ 23 ].…”

“…Although surgical removal of the endometriotic lesions is an alternate treatment modality, the recurrence rate is up to 50% within five years of surgery. An increasing number of studies have explored diet as a therapeutic strategy for endometriosis, especially in the light of current evidence suggesting an association between benign gynecological conditions, including endometriosis, and cardiometabolic risk and systemic inflammation [ 23 , 60 ]. In the following section, we review the current evidence regarding the association of nutrition and diet with endometriosis, focusing on clinical studies ( Figure 2 ).…”

The role of obesity in female reproductive conditions: A Mendelian Randomisation study

“…Leptin, which is a hormone secreted by adipocytes, and elevated in individuals with obesity, is increased in women with endometriosis, UF, and adverse pregnancy outcomes, even when adjusted for BMI (7,(18)(19)(20)(21). Obesity-induced insulin resistance additionally increases the risk and severity of PCOS and pre-eclampsia by dysregulating steroid hormone and metabolic pathways (5,22,23). The dysregulation of sex hormones, including oestrogen and testosterone, is likely to play a role in the obesity-driven development of female reproductive disorders due to its close associations with body fat (22,24).…”