Pain Characteristics, Cardiovascular Risk Factors, and Cardiovascular Disease

There is unclear evidence that chronic pain may increase the risk of cardiovascular disease (CVD) incidence and mortality. This work evaluated the association between chronic pain, incidence of CVD, and changes in CVD risk factors.

Cohort of 1091 community-dwelling individuals of at least 60 years, free from CVD at baseline, followed up for 6 years. Data on psychosocial factors and CVD risk factors were obtained through validated questionnaires and laboratory measurements. A pain scale ranging from 0 (no pain) to 6 (worst pain) was created according to pain frequency, location, and intensity.

The cumulative incidence of CVD was 4.2% at 3 years and 7.7% at 5 years of follow-up. Compared to individuals without pain in the first 3 years (2012-2015), those with maintained scores of at least 2 showed a mean reduction of 3.57 (-5.77 to -1.37) METs-h/week in recreational physical activity, a 0.38-point (0.04-0.73) increase in psychological distress, and a 1.79 (1.03-3.11) higher odds of poor sleep. These associations held in the second follow-up period, when individuals with maintained pain also worsened their diet quality. A 1-point increase in the pain scale in 2012 was associated with a 1.21 (1.03-1.42) and 1.18 (0.97-1.44) increased CVD incidence in 2015 and 2017, respectively; none of the studied factors mediated this relationship.

Older adults with chronic pain show important reductions in recreational physical activity and deterioration in mental health, sleep, and diet quality, which may well aggravate pain. Future studies should evaluate whether these factors mediate the increased risk of CVD observed in older adults with chronic pain.