Heart disease risk 81% higher for women with uterine fibroids, study finds

Heart disease has long been the leading cause of death among women in the United States, but new research suggests that uterine fibroids, which many don’t even know they have, could put them at much higher risk.

A large study spanning 10 years found that women with leiomyomas had an 81% higher long-term risk of heart disease than those without leiomyomas. Women with fibroids – usually benign tumors that can form on or in the uterus – also had higher individual risks of cerebrovascular, coronary and peripheral artery disease a decade after diagnosis.

The study included more than 2.7 million American women and was led by scientists at the Perelman School of Medicine at the University of Pennsylvania. It was published Wednesday in the Journal of the American Heart Association.

“We hope our study adds to this growing evidence that reproductive health can provide important information about cardiovascular health,” said lead author Julia DiTosto, a doctoral student in epidemiology at Penn. “There is a need to obtain more information on exactly how these conditions are biologically linked, as well as to identify potential cardiovascular prevention strategies.”

Fibroids are a largely underfunded area of ​​women’s health research. In 2024, the National Institutes of Health allocated $17 million to study fibroids, up from $14 million in 2023. For comparison, NIH records show $28 million was spent on endometriosis, $59 million on menopause, and $740 million on breast cancer. Previous studies on fibroids and heart disease were “rare and inconclusive,” DiTosto and his co-authors wrote.

In this new study, researchers looked through a healthcare database containing patient records from 2000 to 2022. About 450,000 women had been diagnosed with fibroids and more than 2.2 million had not. The average age of the patients was 41 years.

The researchers calculated the patients’ risks of heart disease at one, three, five and ten years. For each specific condition studied – including strokes and heart attacks – as well as for heart disease in general, women with fibroids had a higher risk at each follow-up period.

Women with fibroids had a high risk of heart disease across all age groups, races, and ethnicities. However, women under 40 had a stronger link between fibroids and heart disease – and a 251% higher risk at 10 years. This is a particularly surprising finding, DiTosto said, given that older age is a risk factor for heart disease.

Fibroids are known to disproportionately affect black women, who are often diagnosed at younger ages, suffer more severe symptoms, and have larger or more numerous tumors. However, the study found that the risk of heart disease was lowest among black women with fibroids. The risk was both highest and most imprecise among Asian women at one, three and five years. At age 10, the risk was highest among Hispanic women.

“Fibroids aren’t just a gynecological health concern,” DiTosto said. “They can also influence broader conditions, and it’s important to think about health holistically.”

How Fibroids May Increase Heart Disease Risk

Fibroids are extremely common, affecting approximately 26 million American women of childbearing age. According to the Federal Office of Women’s Health, between 20 and 80% of women will develop fibroids before the age of 50.

A woman may have more than one fibroid at a time and in different places in her uterus. A growth can be as small as a seed or as large as a watermelon, making a woman appear pregnant. Treatments range from minimally invasive procedures, such as radiofrequency ablation, which uses heat to damage tumor tissue, to a hysterectomy, and new fibroids can grow even after old ones are surgically removed.

In most cases, women are asymptomatic and unaware that they have fibroids until they have a pelvic exam or imaging. Dr. John Petrozza, co-director of the Integrated Fibroids Program at Massachusetts General Hospital, said women who experience symptoms of fibroids often find them debilitating.

“They incur a lot of healthcare expense to treat fibroid-related symptoms, including heavy menstrual bleeding, iron deficiency anemia, pelvic pressure, bowel symptoms, bladder symptoms and infertility,” said Petrozza, who was not involved in the study.

Fibroids feed on two hormones produced by women of childbearing age — estrogen and progesterone — which could be a clue to their link to heart disease, Petrozza said.

“These hormones can cause other things, like smooth muscle cell proliferation, fibrosis, calcification, which impact your vascular system,” he said. “And then, if you have heavy periods because of the fibroids and you start to get iron deficiency anemia, that has a stress-like effect on your blood pressure.”

Such symptoms can place stress on the entire body, he said, which, in turn, can trigger biological changes, including inflammation.

Fibroids are common in obese people, who may have other underlying conditions that increase their risk of heart disease.

“There’s a potential cause and effect that needs to be explored a little more, but, in my mind, that’s how I envision it being related,” Petrozza said, later adding, “You get this chain reaction that can cause atherosclerotic cardiovascular disease, which has a connection to heart attacks and strokes.”

Who is at risk of developing uterine fibroids?

The observational nature of the study was one of its main limitations, DiTosto said. She and her team analyzed patient records from Optum’s Clinformatics Data Mart, designed for insurance billing, not clinical research.

Although the database allowed researchers to explore a large sample size and long-term outcomes, it did not take into account more granular information such as patient size, number and location of fibroids, “which may provide more insight into the mechanisms behind how fibroids and cardiovascular disease might be linked,” DiTosto said.

The study also did not cover the possible effects of fibroid removal on heart disease risk.

Additionally, the database included only privately insured patients, who may have had access to better fibroid diagnosis and treatment than their uninsured peers.

Women with a family history of tumors are more likely to suffer from them. Other risk factors include older age (up to menopause), obesity, high blood pressure, vitamin D deficiency, alcohol consumption, a diet high in red meat, not having been pregnant, and starting menstruation at an early age.

Petrozza said fibroids are often asymptomatic, but women should be careful not to ignore the warning signs.

“If you notice changes in your menstrual flow, if you notice an increase in abdominal girth, if you just don’t feel good in your pelvis, if you’re going to the bathroom more often, if you’re having difficulty conceiving, those are subtle signs of uterine fibroids,” he said. “This should be grounds for talking to your GP or gynecologist.”