Anemia and Early-Onset Cardiovascular Risk in Premenopausal Women: Evidence from a Nationwide Cohort

Introduction Anemia, particularly iron deficiency anemia, is prevalent among reproductive-aged women and often linked to benign gynecologic disorders such as leiomyoma and adenomyosis. While anemia is a recognized contributor to hemodynamic stress, its role as an independent cardiovascular risk factor in young women remains underexplored. Methods We conducted a nationwide retrospective cohort study using Korean National Health Insur-ance Service data (2011-2023) including 1,706,288 premenopausal women aged 20-53 years with benign uterine disorders and no prior cardiovascular or cerebrovascular disease. Anemia was defined by ICD-10 code D50. Propensity score matching (1:1) was applied to balance cardiovascular risk factors. Outcomes included hypertension, ischemic heart dis-ease (IHD), heart failure (HF), and cerebrovascular disease (CVD). Relative risks (RRs) were estimated overall and stratified by age group and uterine pathology. Results After matching, 627,451 women were included in each group. Anemia was associated with higher risks of hypertension (RR 1.35; 95% CI 1.34-1.37), IHD (RR 1.44; 95% CI 1.42-1.46), HF (RR 1.45; 95% CI 1.43-1.47), and CVD (RR 1.26; 95% CI 1.25-1.28). The relative risk was highest among women aged 20-29 years for hypertension (RR 1.68; 95% CI 1.41-2.02) and CVD (RR 1.45; 95% CI 1.22-1.72). Coexisting uterine leiomyoma conferred the greatest vas-cular risk across all outcomes. Conclusions Anemia is an independent risk factor for early-onset cardiovascular and cerebrovascular disease in women with benign uterine disorders, particularly those younger than 40 years. Incorporating gynecologic assessment into cardiovascular risk screening may enhance early prevention strategies in this population.