Fibromyalgia Linked to Increased Cardiovascular Risk

A fibromyalgia diagnosis was associated with an increased cardiovascular burden, according to a study published in Israel Medical Association Journal.¹

“Several studies have shown that patients with fibromyalgia present with neuroendocrine, inflammatory, and coagulation features linked to cardiovascular disease development,” wrote co-lead investigator Fabiola Atzeni, MD, PhD, associated with the Department of Clinical and Experimental Medicine, University of Messina, Italy, and colleagues. “However, the exact profile of cardiovascular risk factors and events in fibromyalgia remains to be defined.”

Patients with fibromyalgia often experience pain, fatigue, insomnia, and cognitive impairment. Depression, another common co-morbidity, is also linked to higher rates of cardiovascular disease. These symptoms may influence physical activity and lead to the development of metabolic syndrome (MetS), which is a risk factor for cardiovascular disease.²

The impact of these symptoms is of particular importance of late, as a recent study reported depression rates among patients with fibromyalgia increased dramatically during the COVID-19 pandemic. The condition is also associated with concomitant systemic lupus erythematosus, rheumatoid arthritis, psoriatic arthritis, and other autoimmune inflammatory diseases.³

Cardiovascular events and risk factors in this patient population were obtained from the CUORE project and included hypertension, blood pressure after 5 minutes of seated rest, fasting glucose, cholesterol and triglycerides, and diabetes. Specific events were stroke, heart failure, peripheral arterial disease, transient ischemic attack, and ischemic heart disease. The prevalence of these factors and events were compared between patients and the general population.

Eligible patients were recruited from the 2008 – 2012 cohort of the CUORE project and fulfilled the 2010 American College of Rheumatology (ACR) criteria for fibromyalgia. Exclusion criteria included co-morbid severe medical conditions, such as infections, cancer, and autoimmune diseases.

The cross-sectional study included 62 patients with fibromyalgia and 4093 female controls, ranging in age from 35 to 75 years. The mean age of patients was 53.7 years, and the mean duration of symptoms was 9.95 years.

The overall cardiovascular burden was significantly higher in the fibromyalgia cohort when compared with the general Italian population (27.4% vs 2.32%). Diabetes, atrial fibrillation (11.3% vs .3%), hypertension (51.6% vs 37.8%), and transient ischemic attack (16.1% vs .7%) were also higher in the fibromyalgia cohort compared with controls.

There were no significant differences reported in body mass index between patients and controls (27.44 vs 27.1, respectively). Additionally, triglycerides (102.37 vs 105.9, respectively), blood fasting glucose (95.31 vs 94.32, respectively), total and fractionated cholesterol levels (208.03 vs 217.84, respectively) were comparable between groups. The prevalence of MetS did not differ significantly between patients with fibromyalgia and the general population (11.3% vs 18.6%, respectively). However, the MetS rate was underestimated for methodological aspects.

Compared with the fibromyalgia group, myocardial infarction and stroke were slightly higher in the control cohort (0% vs .6%; 0% vs .7%, respectively).

Investigators noted the small number of patients with fibromyalgia limited the study. Additionally, the inability to analyze depression and other lifestyle factors may have hindered results.

“The global cardiovascular burden was strongly increased in fibromyalgia, whereas not all traditional cardiovascular risk factors or events were consistently overrepresented,” investigators concluded. “How this specific profile of cardiovascular risk factors translates into real cardiovascular risk remains to be established and should be the object of future studies. Unravelling the associations between this cardiovascular risk profile and clinical features is warranted.”

References

1. ^{Atzeni F, Cirillo M, D’Amico V, Rodríguez-Carrio J, Corda M, Alciati A. Cardiovascular Risk Factors and Events in Fibromyalgia Patients. Isr Med Assoc J. 2023;25(9):627-630.}
2. ^{Lind L, Sundstrom J, Arnlov J, Risreus U, Lampa E. A longitudinal study over 40 years to study the metabolic syndrome as a risk factor for cardiovascular diseases. Sci Rep 2021; 11: 2978.}
3. ^{Pine, L. (2023, June 21). Depression rates among patients with fibromyalgia increased during COVID-19. HCP Live. https://www.hcplive.com/view/depression-rates-among-patients-with-fibromyalgia-increased-during-covid-19}