A comprehensive meta-analysis has uncovered a significant association between hypertension and an increased risk of endometrial cancer, one of the most common gynecological cancers. The study, led by researchers from the Medical University of Lublin in Poland, analyzed data from 26 observational studies involving over 207,000 endometrial cancer cases. The findings suggest that women with hypertension face a 37% higher risk of developing this type of cancer compared to those without the condition.
The researchers also identified several other factors that can further elevate the risk, including obesity, diabetes, early menstruation, and lack of childbirth. Conversely, the use of oral contraceptives and smoking were found to have a protective effect, lowering the risk of endometrial cancer. These insights could help guide future prevention and management strategies for this disease.
Endometrial cancer is the sixth most common cancer in women worldwide, with over 417,000 new cases reported in 2020. Understanding the relationship between hypertension and this condition is crucial, as high blood pressure affects a significant portion of the global population. This comprehensive meta-analysis provides valuable evidence to support the development of targeted interventions and highlights the need for further research in this area.
Unraveling the Link Between Hypertension and Endometrial Cancer
Endometrial cancer, a type of uterine cancer, is one of the most prevalent gynecological cancers, particularly in developed countries. The latest global estimates indicate that there were over 417,000 new cases of endometrial cancer reported in 2020, resulting in approximately 97,000 deaths. Incidence rates vary significantly across different regions, with the highest rates observed in North America, Europe, and Australia, and the lowest rates primarily found in various African regions and South Central Asia.
Hypertension, or high blood pressure, has long been suspected as a contributing factor to the development of endometrial cancer. However, the exact mechanisms underlying this association have remained unclear. To shed light on this relationship, a team of researchers from the Medical University of Lublin in Poland conducted a comprehensive meta-analysis, examining data from 26 observational studies involving a total of 207,502 endometrial cancer cases.
Table 1 Baseline characteristic of the included studies.
Methodology and Key Findings
The researchers searched various databases, including PubMed, Embase, and the Cochrane Library, for studies published between January 2000 and June 2024. They used the DerSimonian-Laird random-effects model to analyze the data and determine the overall association between hypertension and endometrial cancer risk.
The meta-analysis revealed a significant link between hypertension and an increased risk of endometrial cancer. Specifically, the researchers found that women with hypertension had a 37% higher risk of developing endometrial cancer compared to those without the condition (RR = 1.37, 95% CI: 1.27–1.47, p < 0.001).
Further analysis of the data revealed several additional factors that can influence the risk of endometrial cancer:
Factors that Increase Risk:
- Obesity (BMI ≥ 30 kg/m²): 2.14 times higher risk (95% CI: 1.86–2.46, p < 0.001)
- Diabetes: 1.86 times higher risk (95% CI: 1.65–2.09, p < 0.001)
- Early menarche (age ≤ 11 years): 1.29 times higher risk (95% CI: 1.09–1.53, p = 0.003)
- Nulliparity (never given birth): 1.26 times higher risk (95% CI: 1.13–1.40, p < 0.001)
- Hormone replacement therapy: 1.41 times higher risk (95% CI: 1.05–1.90, p = 0.023)
Factors that Decrease Risk:
- Oral contraceptive use: 0.71 times lower risk (95% CI: 0.63–0.79, p < 0.001)
- Smoking: 0.80 times lower risk (95% CI: 0.76–0.83, p < 0.001)
Interestingly, the researchers did not find a statistically significant association between a family history of cancers and the risk of endometrial cancer.
Potential Mechanisms and Implications
The researchers suggest that the link between hypertension and endometrial cancer may be attributed to several biological mechanisms. Prolonged hypertension can potentially disrupt the process of angiogenesis (the formation of new blood vessels) through the action of matrix metalloproteinases (MMPs). Additionally, hypertension is associated with insulin resistance and increased levels of insulin-like growth factor-1 (IGF-1), which have been linked to cell growth and the progression of neoplastic conditions.
These findings have important implications for the prevention and management of endometrial cancer. The identification of modifiable risk factors, such as obesity, diabetes, and hormone therapy use, highlights the need for targeted interventions and lifestyle modifications to reduce the burden of this disease. Furthermore, the protective effects of oral contraceptives and smoking cessation suggest potential avenues for developing effective strategies to lower the risk of endometrial cancer.
Limitations and Future Research Directions
The meta-analysis was not without its limitations. The researchers noted a high degree of heterogeneity among the included studies, which could be attributed to differences in study design, population characteristics, and adjustments for confounding factors. Additionally, the lack of data on menopausal status and the potential impact of various antihypertensive medications on cancer risk were identified as areas requiring further investigation.
Despite these limitations, this comprehensive meta-analysis provides compelling evidence for the association between hypertension and endometrial cancer risk. The findings underscore the importance of addressing hypertension as a modifiable risk factor and highlight the need for continued research to elucidate the underlying mechanisms and develop more effective prevention and management strategies for endometrial cancer.
Author credit: This article is based on research by Agnieszka Drab, Wiesław Kanadys, Maria Malm, Krystian Wdowiak, Joanna Dolar-Szczasny, Bartłomiej Barczyński.
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