Endometriosis and hypertriglyceridemia, why we care about severity and typology?

Background: While plausible mechanisms exist for an association between endometriosis and hypertriglyceridemia, prior studies have shown inconsistent findings, possibly due to the inability to assess endometriosis severity or subtypes. Objectives: Among 473 premenopausal individuals undergoing gynecologic laparoscopy, the present study assessed the association between incident endometriosis and non-fasting serum triglycerides. Methods: Participants were recruited (2007-2009) among women undergoing diagnostic or therapeutic laparoscopy or laparotomy (for any indication) and who had no prior endometriosis diagnosis. Endometriosis was categorized using American Society for Reproductive Medicine staging (I-IV). Typology was defined as superficial endometriosis [SE], ovarian endometrioma [OE], and deep infiltrating endometriosis [DE]. We collected biospecimens, anthropometrics, and self-reported sociodemographics at enrollment, prior to surgery. We evaluated the association between endometriosis diagnosis, stage, typology, and triglyceride concentrations using non-fasting female cutpoints (normal <175mg/dL vs hypertriglyceridemia ≥175mg/dL) via generalized linear models. We also evaluated whether the association differed by menstrual cycle phase. Results: Among the cohort, 108 women (23%) had hypertriglyceridemia > 175 mg/dL. Overall, endometriosis was not associated with prevalence of hypertriglyceridemia (adjusted prevalence ratio (aPR): 1.24, 95% CI: 0.87, 1.77), after accounting for baseline age, race/ethnicity, marital status, BMI, income, and serum cotinine. However, this varied by stage and type. Women with moderate to severe stage endometriosis had a higher aPR for hypertriglyceridemia, 1.74 (95% CI: 1.03, 2.95), compared to those without endometriosis. DE combined with OE was associated with a 3.59 higher aPR (95% CI: 2.33, 5.54) for hypertriglyceridemia. A pattern emerged showing stronger associations in the follicular phase compared to the luteal phase. Conclusions: In summary, while no association was observed for overall endometriosis and hypertriglyceridemia, we observed moderate to severe stage endometriosis as well as DE and OE endometriosis was associated with prevalence of hypertriglyceridemia.