Fibromyalgia and Risk of Coronary Heart Disease: A Population-Based Cohort Study

Purpose:

Prospective cohort studies have shown that depression is associated with an increased subsequent risk of CHD. Depression and chronic pain, such as that in fibromyalgia, often occur simultaneously, and studies have suggested that the two diseases may share common pathogenic mechanisms. This study examined whether fibromyalgia patients have an increased risk of adverse coronary events, compared with age- and sex-matched control patients. We hypothesized that fibromyalgia increases the risk of coronary heart disease (CHD). 

Methods:

Using a matched-cohort study design, we analyzed data retrieved from the Longitudinal Health Insurance Database (LHID) 2000 released by the National Health Research Institutes, Taiwan. The LHID2000 includes medical claims data and registration files for 1 million enrollees randomly selected from the 2000 Registry for Beneficiaries (n = 23.72 million) of the National Health Insurance program. Patients treated for fibromyalgia at least once a month for 3 consecutive months following their initial diagnosis were enrolled in our study. The primary endpoint was the composite of CHD events, including percutaneous coronary intervention and coronary artery bypass grafting procedures. The hazard ratios (HRs) and the 95% confidence intervals (CIs) were estimated using multivariate Cox proportional-hazards regression models.

Results:

After adjusting for the prognostic factors that differed significantly between the fibromyalgia and comparison cohorts, including diabetes mellitus, hypertension, hyperlipidemia, chronic obstructive pulmonary disease, antidepressant use, non-steroids anti-inflammatory drug use, cardiovascular drug use, and the number of cardiology visits, the patients with fibromyalgia showed a significantly higher subsequent risk of a CHD event (HR = 2.19, 95% CI = 1.52 - 3.17, P<0.001) than the patients without fibromyalgia.

Conclusion: Patients with fibromyalgia had at least twice the risk of a subsequent coronary event when compared to those without fibromyalgia.