Increased Risk of Coronary Heart Disease in Patients with Primary Fibromyalgia and Those with Concomitant Comorbidity—A Taiwanese Population-Based Cohort Study
September
Increased Risk of Coronary Heart Disease in Patients with Primary Fibromyalgia and Those with Concomitant Comorbidity-A Taiwanese Population-Based Cohort Study
Chia-Hsien Su 0 1
Jiunn-Horng Chen 0 1
Joung-Liang Lan 0 1
Yu-Chiao Wang 0 1
Chun- Hung Tseng 0 1
Chung-Yi Hsu 0 1
Lichi Huang 0 1
0 Editor: Takeru Abe, Yokohama City University , JAPAN
1 1 Department of Public Health, China Medical University , Taichung, Taiwan , 2 Department of Nursing, China Medical University Hospital , Taichung, Taiwan , 3 School of Medicine, China Medical University , Taichung, Taiwan , 4 Division of Immunology and Rheumatology, Department of Internal Medicine, China Medical University Hospital , Taichung, Taiwan, 5 Management Office for Health Data , China Medical University Hospital , Taichung, Taiwan , 6 Department of Neurology, China Medical University Hospital , Taichung, Taiwan , 7 Graduate Institute of Clinical Medical Science, China Medical University , Taichung, Taiwan , 8 School of Nursing, China Medical University , Taichung , Taiwan
Fibromyalgia 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. We used a dataset of one million participants, systemically scrambled from the Taiwanese national insurance beneficiaries, to identify 61,612 patients with incident fibromyalgia (ICD9-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.
-
Patients with fibromyalgia had a mean age of 44.1 ± 16.5 years. CHD events developed in
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
Excellence (Grant MOHW104-TDU-B-212-113002);
Academia Sinica Taiwan Biobank, Stroke
Biosignature Project (Grant BM104010092); NRPB
Stroke Clinical Trial Consortium (MOST
103-2325-B039 -006); Tseng-Lien Lin Foundation, Taichung,
Taiwan; Taiwan Brain Disease Foundation, Taipei,
Taiwan; and Katsuzo and Kiyo Aoshima Memorial
Fund. None of the funders played a role in conducting
the research.
Competing Interests: The authors have declared
that no competing interest exist.
with concomitant comorbidities relative to patients with primary fibromyalgia and reference
subjects (no fibromyalgia, no comorbidity).
Conclusions
Our 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.
Fibromyalgia is a syndrome with a broad spectrum of symptoms, including chronic widespread
pain, non-restorative sleep, overwhelming fatigue, emotional swings, and cognitive
dysfunction, with impaired daily social function and life quality [1]. This syndrome involves pain
patterns described as hyperalgesia and allodynia, but evidence is still insufficient to support
fibromyalgia as an inflammatory or neuropathic disease [2].
The worldwide prevalence of fibromyalgia, according to classification criteria of the
American College of Rheumatology (ACR) [3, 4], is ~2–4% of the population [5, 6], with lower
prevalence in Asia [7, 8]. Although its prevalence increases with age, fibromyalgia may occur in
children [9, 10]. Women are 3 to 7 times more commonly diagnosed with fibromyalgia than
men [10]. On the other hand, the recent population-based studies using the modified 2010
classification criteria of American College of Rheumatology [11] reported a higher prevalence
(~5–7%) of fibromyalgia [12, 13]. In general rheumatologic clinics, fibromyalgia is second to
osteoarthritis as the most common condition [14].
Fibromyalgia commonly presents with comorbidity such as psychiatric diseases (major
depressive disorder, anxiety disorder), headache, irritable bowel syndrome, and interstitial
cystitis [15–17]. However, fibromyalgia has seldom been associated with coronary heart disease
(CHD). An association between fibromyalgia and CHD with subclinical left ventricular
dysfunction has been reported in older, female Korean patients [18]. Similarly, Israeli patients who
had received coronary catheterization had significantly greater tenderness and higher scores on
the fibromyalgia impact questionnaire [19]. The present nationwide population-based cohort
study in Taiwan was undertaken to evaluate if there is an independent risk of CHD in patients
with fibromy (...truncated)