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Zhu Y, Xin X, Yu Z, Guan S, Wang J, Liu Q, Dong L, Ye Y. Causal associations of male infertility with stroke: a two-sample Mendelian randomization study. Front Endocrinol (Lausanne) 2024; 15:1338077. [PMID: 38686206 PMCID: PMC11056502 DOI: 10.3389/fendo.2024.1338077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 03/25/2024] [Indexed: 05/02/2024] Open
Abstract
Background Stroke is a devastating global health issue, with high mortality and disability rates. The increasing prevalence of male infertility among reproductive-aged men has become a growing concern worldwide. However, the relationship between male infertility and stroke incidence remains uncertain. This study aimed to address this knowledge gap by employing a Mendelian randomization (MR) approach. Method Utilizing genetic instrumental variables derived from a genome-wide association study (GWAS) on male infertility and stroke, a two-sample MR design was implemented. Five different analysis methods, with inverse-variance weighted as the primary approach, were used to examine the genetic causal associations between male infertility and various stroke subtypes. Heterogeneity analysis, pleiotropy tests, and leave-one-out validation were conducted to assess heterogeneity, evaluate pleiotropy, and ensure the robustness of the findings. Result The results indicate a potential lower risk of small vessel stroke associated with male infertility (odds ratio, 95% confidence interval: 0.82, 0.68 to 0.99, p=0.044), although no significant impact on other stroke subtypes was observed. The study exhibited low heterogeneity and no apparent pleiotropy; however, the stability of the results was not optimal. Conclusion Male infertility might potentially confer a protective effect against small vessel stroke risk. Caution is warranted due to potential confounding factors. Additional studies are necessary to confirm these findings and provide further validation.
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Affiliation(s)
- Yutian Zhu
- Department of Traditional Chinese Medicine, Peking University Third Hospital, Beijing, China
| | - Xiyan Xin
- Department of Traditional Chinese Medicine, Peking University Third Hospital, Beijing, China
| | - Ziyang Yu
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Siqi Guan
- Department of Traditional Chinese Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Jingshang Wang
- Department of Traditional Chinese Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Qiuning Liu
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Lei Dong
- Key Laboratory of RNA Biology, Center for Big Data Research in Health, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
| | - Yang Ye
- Department of Traditional Chinese Medicine, Peking University Third Hospital, Beijing, China
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2
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Mormile R. Potential hypothesis for the increased risk of stroke in women with endometriosis. Eur J Obstet Gynecol Reprod Biol 2024; 292:270. [PMID: 38044255 DOI: 10.1016/j.ejogrb.2023.11.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 12/05/2023]
Affiliation(s)
- Raffaella Mormile
- Division of Pediatrics and Neonatology, Moscati Hospital, Aversa, Italy.
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3
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Okoli U, Charoenngam N, Ponvilawan B, Jaroenlapnopparat A, Mettler S, Obiejesie O. Endometriosis and Risk of Cardiovascular Disease: Systematic Review and Meta-Analysis. J Womens Health (Larchmt) 2023; 32:1328-1339. [PMID: 37856152 DOI: 10.1089/jwh.2023.0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023] Open
Abstract
Background: Endometriosis is a common disease affecting 10% of reproductive-age women globally and is associated with chronic systemic inflammation. Some studies suggest that women with endometriosis have a higher risk of cardiovascular disease, whereas others have conflicting findings. This study aims to further investigate the association between endometriosis and cardiovascular disease. Methods: A systematic review was conducted using the EMBASE and MEDLINE databases from inception to October 2022. The search strategy comprised terms for "endometriosis" and "cardiovascular disease." Eligible studies had to include one group of patients with endometriosis and another group of individuals without endometriosis. The study must then compare the incidence or prevalence of cardiovascular disease (major adverse cardiovascular events [MACE], ischemic heart disease [IHD], cerebrovascular accident [CVA], or peripheral artery disease [PAD]). Results: A total of 5,401 articles were identified, and 9 studies were eligible for meta-analysis. Pooled analysis showed an increased prevalence of IHD (pooled odds ratio [OR]: 1.22; 95% confidence interval [95% CI]: 0.74-2.02), CVA (pooled OR: 1.28; 95% CI: 1.07-1.53), and PAD (pooled OR: 1.55; 95% CI: 1.35-1.78). Pooled analysis showed an increased incidence of MACE (pooled hazard ratio [HR]: 1.23; 95% CI: 1.14-1.33), IHD (pooled HR: 1.43; 95% CI: 1.28-1.59), and CVA (pooled HR: 1.20; 95% CI: 1.11-1.30). Conclusions: This systematic review and meta-analysis found a statistically significant association between endometriosis and increased risk of cardiovascular disease (MACE, IHD, CVA, PAD).
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Affiliation(s)
- Unoma Okoli
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, Massachusetts, USA
- Department of Medicine, Faculty of Medicine, Imperial College London, United Kingdom
| | - Nipith Charoenngam
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, Massachusetts, USA
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ben Ponvilawan
- Department of Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | | | - Sofia Mettler
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, Massachusetts, USA
| | - Onyenma Obiejesie
- Department of Medicine, Faculty of Medicine, Imperial College London, United Kingdom
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4
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Canis M, Guo SW. In the thicket of fears, doubts, and murky facts: some reflections on treatment modalities for endometriosis-associated pain. Hum Reprod 2023; 38:1245-1252. [PMID: 37023473 DOI: 10.1093/humrep/dead061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/15/2023] [Indexed: 04/08/2023] Open
Abstract
Endometriosis-associated pain can be managed by either surgery or hormonal therapy. The final decision as to which treatment modality to take is based on efficacy and possible complications of different treatment modalities, risk of recurrence, and the patient's wishes and preferences. But in the thicket of fears, doubts, and murky facts, the choice may ultimately be the trade-off between irrational fears and ignorance versus scientific evidence. We elaborate some pros and cons of the two treatment modalities and highlight some notable downsides of hormonal therapy, in particular the possible yet unquantified risk of long-term hormonal therapy for malignant transformation, perhaps with the only exception of combined oral contraceptives. Thus, when discussing with patients, we advocate the approach of discussing the advantages and disadvantages of all treatment options in detail, accounting for the known pros and cons with a full understanding of the predictive irrationality of human beings. For endometriosis-associated pain, surgery is definitely not a failure of medicine but, rather, a viable option, especially given the recently surfaced undercurrent of wariness and dissatisfaction with the current hormonal drugs among patients with endometriosis. Above all, there is a pressing need to fill the knowledge gap of perioperative interventions intended to reduce the risk of recurrence and to fulfill the demand for the development of safe and efficacious non-hormonal therapeutics.
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Affiliation(s)
- Michel Canis
- Department of Obstetrics Gynecology and Reproductive Medicine, CHU Clermont Ferrand, Clermont Ferrand, France
| | - Sun-Wei Guo
- Research Institute, Shanghai Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
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5
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Penrod N, Okeh C, Velez Edwards DR, Barnhart K, Senapati S, Verma SS. Leveraging electronic health record data for endometriosis research. Front Digit Health 2023; 5:1150687. [PMID: 37342866 PMCID: PMC10278662 DOI: 10.3389/fdgth.2023.1150687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/10/2023] [Indexed: 06/23/2023] Open
Abstract
Endometriosis is a chronic, complex disease for which there are vast disparities in diagnosis and treatment between sociodemographic groups. Clinical presentation of endometriosis can vary from asymptomatic disease-often identified during (in)fertility consultations-to dysmenorrhea and debilitating pelvic pain. Because of this complexity, delayed diagnosis (mean time to diagnosis is 1.7-3.6 years) and misdiagnosis is common. Early and accurate diagnosis of endometriosis remains a research priority for patient advocates and healthcare providers. Electronic health records (EHRs) have been widely adopted as a data source in biomedical research. However, they remain a largely untapped source of data for endometriosis research. EHRs capture diverse, real-world patient populations and care trajectories and can be used to learn patterns of underlying risk factors for endometriosis which, in turn, can be used to inform screening guidelines to help clinicians efficiently and effectively recognize and diagnose the disease in all patient populations reducing inequities in care. Here, we provide an overview of the advantages and limitations of using EHR data to study endometriosis. We describe the prevalence of endometriosis observed in diverse populations from multiple healthcare institutions, examples of variables that can be extracted from EHRs to enhance the accuracy of endometriosis prediction, and opportunities to leverage longitudinal EHR data to improve our understanding of long-term health consequences for all patients.
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Affiliation(s)
- Nadia Penrod
- College of Agriculture and Life Sciences, Texas A&M University, College Station, TX, United States
| | - Chelsea Okeh
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, Philadelphia, PA, United States
| | - Digna R. Velez Edwards
- Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, TN, United States
| | - Kurt Barnhart
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Suneeta Senapati
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Shefali S. Verma
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, Philadelphia, PA, United States
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6
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Farland LV, Wang Y, Gaskins AJ, Rich‐Edwards JW, Wang S, Magnus MC, Chavarro JE, Rexrode KM, Missmer SA. Infertility and Risk of Cardiovascular Disease: A Prospective Cohort Study. J Am Heart Assoc 2023; 12:e027755. [PMID: 36847044 PMCID: PMC10111453 DOI: 10.1161/jaha.122.027755] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/17/2023] [Indexed: 03/01/2023]
Abstract
Background Certain symptoms associated with infertility are associated with cardiovascular disease, including menstrual cycle irregularity, early menopause, and obesity; however, few studies have investigated the association between infertility and cardiovascular disease risk. Methods and Results Participants in the NHSII (Nurses' Health Study II) who reported infertility (12 months of trying to conceive without success, including women who subsequently conceived) or who were gravid, with no infertility were followed from 1989 until 2017 for development of incident, physician-diagnosed coronary heart disease (CHD) (myocardial infarction, coronary artery bypass grafting, angioplasty, stent) and stroke. Time-varying Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% CIs and were adjusted a priori for potential confounding variables. Among 103 729 participants, 27.6% reported having ever experienced infertility. Compared with gravid women who had not reported infertility, women with a history of infertility had greater risk of CHD (HR, 1.13 [95% CI, 1.01-1.26]) but not stroke (HR, 0.91 [95% CI, 0.77-1.07]). The association between history of infertility and CHD was strongest among women who reported infertility at an earlier age (HR for infertility first reported at ≤25 years, 1.26 [95% CI, 1.09-1.46]; HR at 26-30 years, 1.08 [95% CI, 0.93-1.25]; HR at >30 years, 0.91 [95% CI, 0.70-1.19]). When we investigated specific infertility diagnoses, elevated risk of CHD was observed among women whose infertility was attributed to an ovulatory disorder (HR, 1.28 [95% CI, 1.05-1.55]) or endometriosis (HR, 1.42 [95% CI, 1.09-1.85]). Conclusions Women with infertility may be at an increased risk of CHD. Risk differed by age at first infertility diagnosis and was restricted to ovulatory- and endometriosis-related infertility.
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Affiliation(s)
- Leslie V. Farland
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public HealthUniversity of ArizonaTucsonAZ
- Department of Obstetrics and Gynecology, College of Medicine‐TucsonUniversity of ArizonaTucsonAZ
| | - Yi‐Xin Wang
- Department of NutritionHarvard T.H. Chan School of Public HealthBostonMA
| | - Audrey J. Gaskins
- Department of Epidemiology, Rollins School of Public HealthEmory UniversityAtlantaGA
| | - Janet W. Rich‐Edwards
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMA
- Division of Women’s Health, Department of Medicine, Brigham and Women’s HospitalHarvard Medical SchoolBostonMA
| | - Siwen Wang
- Department of NutritionHarvard T.H. Chan School of Public HealthBostonMA
| | | | - Jorge E. Chavarro
- Department of NutritionHarvard T.H. Chan School of Public HealthBostonMA
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s HospitalHarvard Medical SchoolBostonMA
| | - Kathryn M. Rexrode
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMA
- Division of Women’s Health, Department of Medicine, Brigham and Women’s HospitalHarvard Medical SchoolBostonMA
| | - Stacey A. Missmer
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMA
- Department of Obstetrics and Gynecology and Reproductive Biology, College of Human MedicineMichigan State UniversityGrand RapidsMI
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7
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Bushnell CD, Kapral MK. Stroke in Women and Unique Risk Factors. Stroke 2023; 54:587-590. [PMID: 36689601 PMCID: PMC10104594 DOI: 10.1161/strokeaha.122.041734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
There has been a plethora of studies focused on female-specific risk factors and sex differences in stroke published in the past year. This article summarizes several of those novel studies which provide new knowledge about the field of stroke in women. The Nurses' Health Study II provides new data on the association between laparoscopically proven endometriosis and future stroke, accounting for the mediation effects of hysterectomy and oophorectomy. In a cohort of women from China, the relationship between hysterectomy, oophorectomy, and stroke is further clarified, accounting for the age at which the procedure is performed. The UK Biobank study provides new information on the relationship between oral contraceptive and hormone replacement therapy and stroke, with analytical techniques that focus on the timing of events related to duration of exposure. Finally, 2 new meta-analyses address the question of whether sex differences exist in the presentation of stroke symptoms.
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Affiliation(s)
- Cheryl D Bushnell
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC (C.D.B.)
| | - Moira K Kapral
- Department of Medicine, University of Toronto, ON, Canada (M.K.K.)
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8
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Zheng M, Zheng S. Endometriosis Increases the Risk of Stroke: A Mendelian Randomization Study. Stroke 2023; 54:e30-e33. [PMID: 36689595 DOI: 10.1161/strokeaha.122.041163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Ming Zheng
- Institute of Military Cognition and Brain Sciences, Academy of Military Medical Sciences, Beijing, China (M.Z.)
- Beijing Institute of Basic Medical Sciences, China (M.Z.)
| | - Shaoping Zheng
- Departments of Obstetrics and Gynecology, Fuzhou General Hospital, Fujian, China (S.Z.)
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9
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Abstract
Endometriosis affects approximately 190 million women and people assigned female at birth worldwide. It is a chronic, inflammatory, gynecologic disease marked by the presence of endometrial-like tissue outside the uterus, which in many patients is associated with debilitating painful symptoms. Patients with endometriosis are also at greater risk of infertility, emergence of fatigue, multisite pain, and other comorbidities. Thus, endometriosis is best understood as a condition with variable presentation and effects at multiple life stages. A long diagnostic delay after symptom onset is common, and persistence and recurrence of symptoms despite treatment is common. This review discusses the potential genetic, hormonal, and immunologic factors that lead to endometriosis, with a focus on current diagnostic and management strategies for gynecologists, general practitioners, and clinicians specializing in conditions for which patients with endometriosis are at higher risk. It examines evidence supporting the different surgical, pharmacologic, and non-pharmacologic approaches to treating patients with endometriosis and presents an easy to adopt step-by-step management strategy. As endometriosis is a multisystem disease, patients with the condition should ideally be offered a personalized, multimodal, interdisciplinary treatment approach. A priority for future discovery is determining clinically informative sub-classifications of endometriosis that predict prognosis and enhance treatment prioritization.
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Affiliation(s)
- Andrew W Horne
- EXPPECT Edinburgh and MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Stacey A Missmer
- Michigan State University, Grand Rapids, MI, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
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10
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Introduction to the special issue on neurological disorders across the female life span. Neurobiol Dis 2022; 174:105886. [DOI: 10.1016/j.nbd.2022.105886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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