Longitudinal Pain Patterns and Cardiovascular Disease Risk in Chinese Menopausal Women: The Mediating Roles of
Fangfang Ding1, Yan Han2, Jiajun Huang1
1Department of Anesthesiology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China.
Insights
Persistent pain in menopausal women, especially when long-standing or affecting multiple body sites, is linked to increased cardiovascular disease (CVD) risk. Depressive symptoms and body mass index (BMI) partially mediate this association.
Area of Science:
- Gerontology
- Cardiology
- Pain Medicine
Background:
- Cardiovascular disease (CVD) and chronic pain are prevalent in menopausal women.
- Limited understanding exists on how pain course (persistence, multisite involvement) impacts future CVD risk in this demographic.
Purpose of the Study:
- To investigate the longitudinal association between pain phenotypes (persistent, multisite) and incident CVD in postmenopausal women.
- To evaluate the mediating roles of depressive symptoms and body mass index (BMI) in this relationship.
Main Methods:
- Prospective analysis of 4,890 postmenopausal women from the China Health and Retirement Longitudinal Study (CHARLS).
- Pain status and CVD assessed at baseline (2013) and follow-up (2018).
- Regression and mediation analyses used to examine associations and mediators.
Main Results:
- Persistent pain phenotypes, including general, low back, and multisite pain, predicted incident CVD over five years.
- Depressive symptoms mediated 21.6% of the association for persistent pain.
- For persistent low back pain, depressive symptoms (14.5%) and BMI (5.4%) were significant mediators.
Conclusions:
- Long-standing and multisite pain in postmenopausal women is associated with elevated future CVD risk.
- Depressive symptoms and BMI partially explain these associations.
- Assessing pain patterns, mood, and metabolic health can identify at-risk women.
Purpose:
Cardiovascular disease (CVD) and chronic pain substantially affect menopausal women. However, evidence is scarce regarding how the course of pain over time-specifically, whether it is persistent and affects multiple body sites-influences the future risk of CVD in this population. This study aimed to investigate the longitudinal association between these novel pain phenotypes and incident CVD, and to evaluate the mediating roles of depressive symptoms and body mass index (BMI).
Patients And Methods:
This prospective analysis included 4,890 postmenopausal women from the China Health and Retirement Longitudinal Study (CHARLS). Pain status (location, intensity) and CVD were assessed at baseline (2013) and follow-up (2018). Persistent pain was defined as pain reported at both time points. We used regression models to examine the association between pain patterns and incident CVD, and mediation analysis to quantify the contribution of depressive symptoms and BMI.
Results:
At baseline (cross-sectional), pain presence, intensity, and multisite distribution were associated with higher CVD prevalence. Over five years (longitudinal), persistent pain phenotypes predicted incident CVD after adjustment: general persistent pain (OR = 1.05, 95% CI: 1.00-1.08, p = 0.012), persistent low back pain (OR = 1.08, 95% CI: 1.03-1.13, p = 0.001), and persistent multisite pain (OR = 1.06, 95% CI: 1.00-1.11, p = 0.020). Depressive symptoms mediated 21.6% of the association for persistent pain; for persistent low back pain, depressive symptoms (14.5%) and BMI (5.4%) were significant mediators.
Conclusion:
Among postmenopausal women, long-standing and multisite pain is associated with higher future CVD risk. A modest portion of these associations was statistically accounted for by depressive symptoms and, for low back pain, BMI. Assessing pain persistence and distribution may help identify women who could benefit from integrated appraisal of pain, mood, and metabolic health.
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