Increased Risk of Coronary Heart Disease in Patients with Primary Fibromyalgia and Those with Concomitant Comorbidity—A Taiwanese Population-Based Cohort Study

Abstract

ObjectivesFibromyalgia has seldom been associated with coronary heart disease (CHD). The aim of this study was to evaluate the risk of CHD in patients with fibromyalgia.MethodsWe used a dataset of one million participants, systemically scrambled from the Taiwanese national insurance beneficiaries, to identify 61,612 patients with incident fibromyalgia (ICD-9-CM 729.0–729.1) and 184,834 reference subjects matched by sex, age and index date of diagnosis in a 1:3 ratio from 2000 to 2005, with a mean 8.86 ± 2.68 years of follow-up until 2011. Risk of CHD was analyzed by Cox proportional hazard modeling.ResultsPatients with fibromyalgia had a mean age of 44.1 ± 16.5 years. CHD events developed in fibromyalgia patients (n = 8,280; 15.2 per 103 person-years) and reference subjects (n = 15,162; 9.26 per 103 person-years) with a significant incidence rate ratio of 1.64 (95% confidence interval: 1.61–1.68). The adjusted hazard ratio for CHD in fibromyalgia patients relative to reference subjects was 1.47 (1.43–1.51), after adjusting for age, gender, occupation, monthly income, traditional cardiovascular comorbidities, depression and anxiety. We noted that fibromyalgia and cardiovascular comorbidities had a significant interaction effect on CHD risk (p for interaction <0.01), which was markedly enhanced in fibromyalgia patients with concomitant comorbidities relative to patients with primary fibromyalgia and reference subjects (no fibromyalgia, no comorbidity).ConclusionsOur report shows that fibromyalgia patients have an independent risk for CHD development. Fibromyalgia patients with concomitant comorbidities have markedly increased CHD risk relative to those with primary fibromyalgia.

Is Fibromyalgia Risk Higher Among Male and Young Inflammatory Bowel Disease Patients? Evidence from a Taiwan Cohort of One Million

“…Studies have revealed that apart from traditional inflammation-related cardiovascular risk factors, such as diabetes (4,5,9,10), hyperlipidemia (4,9,10), hypertension (4,5,9,10), depression (1-5,9,10), anxiety (1)(2)(3)(4)(5)(8)(9)(10), and sleep disorders (1)(2)(3)(4)(5)(6)8,10), diseases characterized by inflammatory processes (e.g., RA (14,15) and SLE (15,16)), and infectious courses (such as HCV (11)(12)(13) and HIV (11)(12)(13)) can also enhance the risk of FM. In addition to these well-known inflammatory sources, other less-notified inflammatory diseases (e.g., IBD) should be considered as possible causes of FM.…”

“…Because FM-associated comorbidities were more commonly seen among the older population (2,4,10,13), the most important risk factor for FM was age, especially old age (2,4,10,13). The age-related effect on FM development was also reflected in the FM incidences in both the IBD and non-IBD groups (Table 2).…”

“…Through peripheral and central sensitizations, inflammatory mediators (either peripheral-or central-derived) can stimulate pain pathways in the brain and spinal cord, and through certain pathophysiological alterations in the brain, including dysfunctions in neuroendocrine systems and imbalances in neurotransmitter metabolisms, FM can be elicited (6)(7)(8). With pathophysiological effects possibly similar to those triggered by inflammatory mediators, FM can also be induced by some well-known inflammationassociated cardiovascular risk factors, including diabetes (4,5,9,10), hyperlipidemia (4,9,10), and hypertension (4,5,9,10), and certain neuropsychiatric conditions, such as depression (1-5,9,10), anxiety (1-5,8-10), and sleep disorders (1)(2)(3)(4)(5)(6)8,10). Nevertheless, even after rigorous explorations, the conventional risk factors cannot be detected in some FM patients.…”

“…In this study, the diagnosis of FM (ICD-9-CM code 729.1), which was with validity and accuracy according to those used in previous literatures (10,(30)(31)(32), during the study period was the study end-point. In order to keep the FM diagnoses as accurate as possible, only those who have had the diagnoses of FM for at least 3 times during the study period were thought to be the victims of FM in this study.…”

“…Several FM-associated comorbidities have been established in the literature (1-6,8-10). Among them, female (2,4,10-13), age (2,4,10,13), diabetes (4,5,9,10), hyperlipidemia (4,9,10), hypertension (4,5,9,10), depression (1-5,9,10), anxiety (1-5,8-10), and sleep disorders (1)(2)(3)(4)(5)(6)8,10) have been demonstrated to exert differential effects. The results of the present investigation indicate that the NHIRD is suitable to seek additional FM risk factors such as IBD.…”