{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T05:18:42Z","timestamp":1787635122421,"version":"build-2736575974"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The association between hypertension identified in early adulthood and uterine fibroid development in young women remains poorly understood. Therefore, we aimed to evaluate the association between hypertension identified in early adulthood and uterine fibroid development in reproductive-age women.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this nationwide population-based cohort study, we used data from the Korean National Health Insurance Service, health screening and claims database. A total of 2,558,659 women aged 20\u201339 years without a prior diagnosis of uterine fibroids were enrolled between 2009\u20132012 and followed for a mean duration of 11.54 years until December 31, 2023. The main outcome measures were incident uterine fibroids and adjusted hazard ratios (HRs) according to blood pressure categories. Blood pressure was categorized as normotension, elevated\/stage 1 hypertension, stage 2 hypertension, or treated hypertension according to national guidelines. Incident uterine fibroids were identified using International Classification of Disease 10\n                      <jats:sup>th<\/jats:sup>\n                      revision code D25. Cox proportional hazards models were used to estimate HRs and 95% confidence intervals (CIs), adjusting for demographic factors, lifestyle behaviors, body mass index (BMI), metabolic comorbidities, and healthcare utilization.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      During follow-up, 373,379 women (14.59%) developed uterine fibroids. Compared with normotensive women, elevated\/stage 1 hypertension (adjusted HR 1.04; 95% CI 1.03\u20131.05) and stage 2 hypertension (adjusted HR 1.06; 95% CI 1.04\u20131.09) were associated with a progressively increased risk of incident uterine fibroids (all\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001). Women receiving antihypertensive medication exhibited the highest risk (adjusted HR 1.10; 95% CI 1.06\u20131.14;\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001). These associations were stronger among women with BMI &amp;lt; 25 kg\/m\u00b2 compared with those with BMI \u2265 25 kg\/m\u00b2 (\n                      <jats:italic>P<\/jats:italic>\n                      for interaction &amp;lt; 0.0001), and among women with waist circumference &amp;lt; 85\u00a0cm compared with those with waist circumference \u2265 85\u00a0cm (\n                      <jats:italic>P<\/jats:italic>\n                      for interaction = 0.0005). No association was observed according to antihypertensive medication class.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Hypertension identified in early adulthood was independently and progressively associated with incident uterine fibroids in reproductive-age women. These findings suggest that blood pressure dysregulation during early adulthood may be relevant to uterine fibroid risk in young women.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1822452","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T04:22:59Z","timestamp":1787631779000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Hypertension identified in early adulthood as an endocrine\u2013vascular risk factor for uterine fibroids in reproductive-age women: a nationwide cohort study"],"prefix":"10.3389","volume":"17","author":[{"given":"Soyeon","family":"Kang","sequence":"first","affiliation":[{"name":"Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, St. Vincent\u2019s Hospital, College of Medicine, The Catholic University of Korea","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyungdo","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Statistics and Actuarial Science, Soongsil University","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Youn-Jee","family":"Chung","sequence":"additional","affiliation":[{"name":"Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,25]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.14640","article-title":"Epidemiology of uterine fibroids: a systematic review","volume":"124","author":"Stewart","year":"2017","journal-title":"Bjog"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1093\/humupd\/dmw023","article-title":"Uterine fibroid management: from the present to the future","volume":"22","author":"Donnez","year":"2016","journal-title":"Hum Reprod Update"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/s0029-7844(99)00605-5","article-title":"Complications in pregnancy, labor, and delivery with uterine leiomyomas: a population-based study","volume":"95","author":"Coronado","year":"2000","journal-title":"Obstet Gynecol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1002\/rcs.1742","article-title":"Robot-assisted laparoscopic myomectomy for deep intramural myomas","volume":"13","author":"Kang","year":"2017","journal-title":"Int J Med Robot"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2024.02.049","article-title":"Uterine fibroid-related infertility: mechanisms and management","volume":"122","author":"Donnez","year":"2024","journal-title":"Fertil Steril"},{"key":"B6","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1067\/mob.2003.118","article-title":"Expression, menstrual cycle-dependent activation, and bimodal\u00a0mitogenic effect of transforming growth factor-beta1 in human myometrium and leiomyoma","volume":"188","author":"Arici","year":"2003","journal-title":"Am J Obstet Gynecol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1097\/aog.0000000000005661","article-title":"Intramural leiomyomas and fertility: a systematic review and meta-analysis","volume":"144","author":"Pritts","year":"2024","journal-title":"Obstet Gynecol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0269478","article-title":"The risk of preterm birth in women with uterine fibroids: a systematic review and meta-analysis","volume":"17","author":"Landman","year":"2022","journal-title":"PloS One"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD003857.pub4","article-title":"Surgical treatment of fibroids for subfertility","volume":"1","author":"Metwally","year":"2020","journal-title":"Cochrane Database Syst Rev"},{"key":"B10","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1002\/ijgo.13102","article-title":"Epidemiology and management of uterine fibroids","volume":"149","author":"Giuliani","year":"2020","journal-title":"Int J Gynaecol Obstet"},{"key":"B11","doi-asserted-by":"publisher","first-page":"R1","DOI":"10.1530\/rep-21-0087","article-title":"Vascular biology of uterine fibroids: connecting fibroids and vascular disorders","volume":"162","author":"Kirschen","year":"2021","journal-title":"Reproduction"},{"key":"B12","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1016\/j.fertnstert.2024.02.048","article-title":"Pathogenesis of uterine fibroids: current understanding and future directions","volume":"122","author":"Dolmans","year":"2024","journal-title":"Fertil Steril"},{"key":"B13","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1093\/humupd\/dmx032","article-title":"Extracellular matrix in uterine leiomyoma pathogenesis: a potential target for future therapeutics","volume":"24","author":"Islam","year":"2018","journal-title":"Hum Reprod Update"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1007\/s43032-023-01215-x","article-title":"Relationship among surgical fibroid removal, blood pressure, and biomarkers of renin-angiotensin-aldosterone system activation","volume":"30","author":"Kirschen","year":"2023","journal-title":"Reprod Sci"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1142\/9789819807024_0021","article-title":"Uterine fibroids show evidence of shared genetic architecture with blood pressure traits","volume":"30","author":"Akerele","year":"2025","journal-title":"Pac Symp Biocomput"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwi072","article-title":"A prospective study of hypertension and risk of uterine leiomyomata","volume":"161","author":"Boynton-Jarrett","year":"2005","journal-title":"Am J Epidemiol"},{"key":"B17","article-title":"Fibroids and hypertension. A cross-sectional study of women undergoing hysterectomy","volume":"46","author":"Luoto","year":"2001","journal-title":"J Reprod Med"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.6832","article-title":"Hypertension, cardiovascular risk factors, and uterine fibroid diagnosis in midlife","volume":"7","author":"Mitro","year":"2024","journal-title":"JAMA Netw Open"},{"key":"B19","doi-asserted-by":"publisher","first-page":"395","DOI":"10.4093\/dmj.2014.38.5.395","article-title":"Background and data configuration process of a nationwide population-based study using the korean national health insurance system","volume":"38","author":"Song","year":"2014","journal-title":"Diabetes Metab J"},{"key":"B20","doi-asserted-by":"publisher","first-page":"799","DOI":"10.1093\/ije\/dyw253","article-title":"Data resource profile: the national health information database of the national health insurance service in South Korea","volume":"46","author":"Cheol Seong","year":"2017","journal-title":"Int J Epidemiol"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.4093\/dmj.2020.0207","article-title":"Data configuration and publication trends for the Korean National Health Insurance and Health Insurance Review & Assessment Database","volume":"44","author":"Kim","year":"2020","journal-title":"Diabetes Metab J"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1080\/19371910903070333","article-title":"Introduction: health of the health care system in Korea","volume":"25","author":"Kim","year":"2010","journal-title":"Soc Work Public Health"},{"key":"B23","doi-asserted-by":"publisher","first-page":"10291","DOI":"10.1038\/s41598-020-67329-3","article-title":"Hypertension is associated with oral, laryngeal, and esophageal cancer: a nationwide population-based study","volume":"10","author":"Seo","year":"2020","journal-title":"Sci Rep"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1186\/s40885-014-0012-3","article-title":"2013 Korean Society of Hypertension guidelines for the management of hypertension: part I-epidemiology and diagnosis of hypertension","volume":"21","author":"Shin","year":"2015","journal-title":"Clin Hypertens"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.30405","article-title":"Association of female reproductive factors with incidence of fracture among postmenopausal women in Korea","volume":"4","author":"Yoo","year":"2021","journal-title":"JAMA Netw Open"},{"key":"B26","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1186\/s12933-019-0909-y","article-title":"Severe hypoglycemia and the risk of cardiovascular disease and mortality in type 2 diabetes: a nationwide population-based cohort study","volume":"18","author":"Yun","year":"2019","journal-title":"Cardiovasc Diabetol"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.3904\/kjim.2017.402","article-title":"Site-specific cancer risk in patients with type 2 diabetes: a nationwide population-based cohort study in Korea","volume":"35","author":"Kim","year":"2020","journal-title":"Korean J Intern Med"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1161\/hyp.0000000000000066","article-title":"2017 ACC\/AHA\/AAPA\/ABC\/ACPM\/AGS\/APhA\/ASH\/ASPC\/NMA\/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines","volume":"71","author":"Whelton","year":"2018","journal-title":"Hypertension"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1016\/0020-7292(87)90349-3","article-title":"Uterine fibromyomata: presentation and management in northern Nigeria","volume":"25","author":"Emembolu","year":"1987","journal-title":"Int J Gynaecol Obstet"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/153.1.11","article-title":"Risk factors for uterine leiomyoma: a practice-based case-control study. II. Atherogenic risk factors and potential sources of uterine irritation","volume":"153","author":"Faerstein","year":"2001","journal-title":"Am J Epidemiol"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1159\/000114250","article-title":"Relationship between metabolic syndrome and uterine leiomyomas: a case-control study","volume":"66","author":"Takeda","year":"2008","journal-title":"Gynecol Obstet Invest"},{"key":"B32","first-page":"595","article-title":"Epidemiology of uterine leiomyomas. With an etiologic hypothesis","volume":"40","author":"Cramer","year":"1995","journal-title":"J Reprod Med"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1097\/01.hjh.0000226182.60321.69","article-title":"Role of the renin-angiotensin-aldosterone system in vascular remodeling and inflammation: a clinical review","volume":"24","author":"Duprez","year":"2006","journal-title":"J Hypertens"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1056\/nejm199411103311907","article-title":"Transforming growth factor beta in tissue fibrosis","volume":"331","author":"Border","year":"1994","journal-title":"N Engl J Med"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.0000020689.12472.e0","article-title":"Transforming growth factor-beta function blocking prevents myocardial fibrosis and diastolic dysfunction in pressure-overloaded rats","volume":"106","author":"Kuwahara","year":"2002","journal-title":"Circulation"},{"key":"B36","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/s0015-0282(02)03154-0","article-title":"Interactions of cytokines, growth factors, and the extracellular matrix in the cellular biology of uterine leiomyomata","volume":"78","author":"Sozen","year":"2002","journal-title":"Fertil Steril"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1161\/01.hyp.31.2.672","article-title":"Abnormal regulation of transforming growth factor-beta receptors on vascular smooth muscle cells from spontaneously hypertensive rats by angiotensin II","volume":"31","author":"Fukuda","year":"1998","journal-title":"Hypertension"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1161\/hypertensionaha.119.13069","article-title":"Early\u00a0onset hypertension is associated with hypertensive end-organ damage already\u00a0by midlife","volume":"74","author":"Suvila","year":"2019","journal-title":"Hypertension"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.04.038","article-title":"Association of age of onset of hypertension with cardiovascular diseases and mortality","volume":"75","author":"Wang","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j1949","article-title":"Heritability and risks associated with early onset hypertension: multigenerational, prospective analysis in the Framingham Heart Study","volume":"357","author":"Niiranen","year":"2017","journal-title":"Bmj"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.04.059","article-title":"Early-onset hypertension: under-recognized, under-treated, and under-estimated in risk","volume":"75","author":"Niiranen","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1093\/ajh\/hpab066","article-title":"Clinical correlates of early-onset hypertension","volume":"34","author":"Suvila","year":"2021","journal-title":"Am J Hypertens"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.11.006","article-title":"2017 ACC\/AHA\/AAPA\/ABC\/ACPM\/AGS\/APhA\/ASH\/ASPC\/NMA\/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines","volume":"71","author":"Whelton","year":"2018","journal-title":"J Am Coll Cardiol"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehy339","article-title":"2018 ESC\/ESH Guidelines for the management of arterial hypertension","volume":"39","author":"Williams","year":"2018","journal-title":"Eur Heart J"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1161\/hypertensionaha.117.09801","article-title":"Trends in the prevalence, awareness, treatment, and control of hypertension among young adults in the United States, 1999 to 2014","volume":"70","author":"Zhang","year":"2017","journal-title":"Hypertension"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1822452\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T04:23:01Z","timestamp":1787631781000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1822452\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,25]]},"references-count":45,"alternative-id":["10.3389\/fendo.2026.1822452"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2026.1822452","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,25]]},"article-number":"1822452"}}