Hypertension and Endometrial Cancer Risk: A Systematic Review and Meta-Analysis
Hypertension is a significant global health concern, contributing to millions of deaths and disabilities, and is associated with various risk factors such as obesity and physical inactivity. Endometrial cancer, the sixth most common cancer in women, has rising incidence rates linked to age and obesity. However, the connection between hypertension and the risk of endometrial cancer remains unclear. This uncertainty prompted researchers to complete a systematic review and meta-analysis to investigate this association and identify modifying factors.
Following PRISMA 2020 guidelines, researchers reviewed studies published in English from January 2000 to June 2024, sourcing data from PubMed, Embase, and the Cochrane Library. They targeted case-control and cohort studies that provided original data on the link between hypertension and endometrial cancer incidence, excluding studies that focused on elevated blood pressure, survival, or mortality, or lacked sufficient data.
Data extraction was conducted by 2 independent reviewers who assessed abstracts and references for additional studies. The quality of the included studies was evaluated using the Newcastle-Ottawa Scale (NOS), with scores ranging from 5 to 9 and an average of 6.69. Statistical analyses were performed using the STATISTICA 13.3 program, applying a random-effects model to calculate risk ratios with 95% confidence intervals (CIs). Publication bias was evaluated through Egger’s and Begg’s tests, alongside funnel plot inspections, while heterogeneity was assessed using the I² statistic. Subgroup analyses considered factors such as family cancer history, obesity, and smoking, with significance set at P < .05.
The meta-analysis included data from 20 case-control studies involving 8938 cases and 41,265 controls, as well as 6 cohort studies with 198,564 cases and 943,713 participants. Initially, 7427 articles were identified; after screening, 26 studies were included. The findings revealed that individuals with hypertension have a 1.37 times higher risk of developing endometrial cancer (95% CI: 1.27-1.47; P < 0.001). This risk was more pronounced in case-control studies (1.59 times higher) compared to cohort studies (1.24 times higher). Among the 20 case-control studies, 19 reported significant associations, while only 2 cohort studies did.
Despite high heterogeneity (I² = 89.89%) among case-control studies, no publication bias was detected. Subgroup analyses indicated significant associations with factors such as BMI, diabetes, and hormone replacement therapy, while the use of oral contraceptives or smoking appeared to reduce risk. Family cancer history did not significantly affect risk.
This meta-analysis demonstrates a significant association between hypertension and endometrial cancer risk (RR 1.37; 95% CI, 1.27-1.47). While the results highlight hypertension's potential role in cancer development through mechanisms like metabolic syndrome, obesity, and diabetes, they also underscore the need for further research to clarify this relationship and explore additional risk factors.
Reference
Drab A, Kanadys W, Malm M, Wdowiak K, Dolar-Szczasny J, Bartłomiej B. Association of endometrial cancer risk with hypertension- an updated meta-analysis of observational studies. Nature. 2024;14(1):24884. doi:10.1038/s41598-024-76896-8
