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

PLOS ONE, Dec 2019

Objectives 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. Methods We 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. Results Patients 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). 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.

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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)


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Chia-Hsien Su, Jiunn-Horng Chen, Joung-Liang Lan, Yu-Chiao Wang, Chun-Hung Tseng, Chung-Yi Hsu, Lichi Huang. Increased Risk of Coronary Heart Disease in Patients with Primary Fibromyalgia and Those with Concomitant Comorbidity—A Taiwanese Population-Based Cohort Study, PLOS ONE, 2015, Volume 10, Issue 9, DOI: 10.1371/journal.pone.0137137