BACKGROUND: The interplay between pain of different chronicity and cardiovascular disease (CVD) is incompletely understood.
AIM: We aimed to investigate the association between different levels of chronic or non-chronic pain and risk of CVD.
METHODS: Participants in the UK Biobank who reported pain at baseline were divided into three groups according to pain duration and widespreadness. Participants reporting no pain were controls. Multivariable Cox regression was used to investigate the association between pain and incidence of myocardial infarction, heart failure, stroke, cardiovascular mortality and composite CVD (defined as any of the before-mentioned cardiovascular events).
RESULTS: Of 475,171 participants, 189,289 reported no pain, 87,830 reported short-term pain, 191,716 chronic localized pain, and 6,336 chronic widespread pain (CWP). During a median of 7.0 years' follow-up, participants with CWP and chronic localized pain had, after adjustment for age, sex, established cardiovascular risk factors, physical activity, anxiety, depression, cancer, chronic inflammatory/painful disease, pain/anti-inflammatory medication, socioeconomic status, a significantly increased risk for composite CVD (hazard ratio, HR 1.14, CI 1.08-1.21, p-value < 0.001; and HR 1.48, CI 1.28-1.73, p-value < 0.001, respectively) compared to controls, with similar results when using the different specific CVDs as outcomes. Population attributable risk proportion for chronic pain as a risk factor for composite CVD was comparable to that of diabetes (8.6% vs. 7.3%, respectively).
CONCLUSIONS: Chronic pain is associated with an increased risk for myocardial infarction, stroke, heart failure and cardiovascular death independent of established cardiovascular risk factors, socioeconomic factors, co-morbidities and medication. Our study, the largest to date, confirms and extends our understanding of chronic pain as an underestimated cardiovascular risk factor with important public health implications.
2022. Vol. 29, no 15, p. 1994-2002, article id zwac127